Behavioral Health Fellowship Evaluation Form
Please assess the fellow’s performance and readiness across multiple professional domains.
Fellow’s Name
*
Evaluator’s Name
*
Professional Competence
*
Needs Improvement
1
2
3
4
Outstanding
5
1 is Needs Improvement, 5 is Outstanding
Clinical Knowledge and Skills
*
Needs Improvement
1
2
3
4
Outstanding
5
1 is Needs Improvement, 5 is Outstanding
Communication with Patients and Team
*
Needs Improvement
1
2
3
4
Outstanding
5
1 is Needs Improvement, 5 is Outstanding
Professionalism and Ethical Behavior
*
Needs Improvement
1
2
3
4
Outstanding
5
1 is Needs Improvement, 5 is Outstanding
Teamwork and Collaboration
*
Needs Improvement
1
2
3
4
Outstanding
5
1 is Needs Improvement, 5 is Outstanding
Growth Areas Assessment
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Demonstrates openness to feedback
1
2
3
4
5
Shows initiative in learning
6
7
8
9
10
Effectively manages stress
11
12
13
14
15
Adapts to new situations
16
17
18
19
20
Overall Readiness for Independent Practice
*
Ready
Needs Further Development
Not Ready
Additional Comments or Recommendations
Submit Evaluation
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