Cultural Competency Diagnostic Evaluation Form
Please complete this evaluation to help us understand your cultural competency strengths and areas for growth.
Name
First Name
Last Name
Role or Position
Briefly describe your background or experience working with people from diverse cultural backgrounds.
*
Please rate your experience and comfort in the following areas:
*
Rows
Not at all comfortable
Somewhat comfortable
Comfortable
Very comfortable
Interacting with people from cultures different than my own
1
2
3
4
Recognizing and respecting cultural differences
5
6
7
8
Adapting my communication style for cultural understanding
9
10
11
12
Navigating misunderstandings due to cultural differences
13
14
15
16
Which of the following culturally competent practices do you regularly engage in? (Select all that apply)
*
Seek out learning about other cultures
Reflect on my own cultural biases
Adapt communication styles as needed
Ask questions to clarify cultural expectations
Participate in cross-cultural training
Other
How would you rate your overall cultural awareness?
*
1
2
3
4
5
How adaptable are you to new or unfamiliar cultural contexts?
*
Not adaptable
1
2
3
4
Highly adaptable
5
1 is Not adaptable, 5 is Highly adaptable
What is one area of cultural competency you would like to improve, and how do you plan to work on it?
*
Submit Evaluation
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