Healthcare Professional Fellowship Evaluation Form
Use this form to evaluate a healthcare professional fellow’s performance, competencies, and overall progress during the fellowship period.
Evaluator and Fellow Information
Evaluator Name
*
First Name
Middle Name
Last Name
Evaluator Role / Title
*
Evaluator Department / Unit
*
Fellow Name
*
First Name
Middle Name
Last Name
Evaluation Period
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Fellowship Evaluation Criteria
Clinical knowledge and skills
*
Rows
Needs Improvement
Satisfactory
Good
Excellent
Clinical knowledge
1
2
3
4
Procedural/technical skills
5
6
7
8
Professionalism
*
1
2
3
4
5
Communication
*
1
2
3
4
5
Teamwork and interprofessional collaboration
*
1
2
3
4
5
Research and quality improvement
*
1
2
3
4
5
Reliability and initiative
*
1
2
3
4
5
Overall Outcome and Comments
Overall Performance Rating
*
1
2
3
4
5
Final Recommendation
*
Pass
Continue Fellowship
Remediate
Advance with Conditions
Other
Comments, Strengths, Concerns, and Recommendations
Submit Evaluation
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