Evaluation Toolkit Survey
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1
. Please rank the usefulness of the Evaluation Toolkit:
Please rank the usefulness of the Evaluation Toolkit:
Not at all
Minimally
Moderately
Very
2
. Were you able to use one or more tools for your evaluation needs?
Were you able to use one or more tools for your evaluation needs?
Multiple tools
One tool
None, in search of other tools
3
. Please provide any suggestions for how we might improve this toolkit, including additional types of evaluation tools:
Please provide any suggestions for how we might improve this toolkit, including additional types of evaluation tools:
4
. Please describe yourself (Choose all that apply):
Please describe yourself (Choose all that apply):
Academic faculty member
Community partner
Residency Program Director
Department Chair
Resident
Chief Resident
Other
5
. Can we contact you for further feedback?
Can we contact you for further feedback?
Yes
No
6
. Would you be interested in submitting any evaluation tools for inclusion in the toolkit?
Would you be interested in submitting any evaluation tools for inclusion in the toolkit?
Yes
No
7
. Would you like to be added to the CPTI listserv?
Would you like to be added to the CPTI listserv?
Yes
No
8
. If you answered yes to any of the last three questions, please provide your name and e-mail address:
If you answered yes to any of the last three questions, please provide your name and e-mail address:
Last Name:
First Name:
E-mail Address:
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