The purpose of this evaluation is to obtain information about your experience, specifically this semester, with your supervisor and while at CCMS. Your honest feedback will help us to maintain a quality training experience for you and for future trainees. Please indicate the option that best fits your opinion about your training experience for this semester in the following domains:

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* 1. Today's Date

Date

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* 2. Name of Evaluator

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* 3. SUPERVISOR:

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* 4. Additional Comments

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* 5. DOMAIN II: SITE INFORMATION

  Strongly Agree Agree Neutral Disagree Strongly Disagree
1. CCMS has provided me with sufficient orientation to its mission, purpose, culture, policies and procedures.
2. CCMS provides appropriate resource and reference materials.
3. CCMS provides adequate opportunity for discussing site and/or training concerns.
4. CCMS helps me to apply what I have learned throughout my program.
5. CCMS staff has been open and helpful to my experience.
6. I have been treated with respect by my fellow colleagues.
7. CCMS provides opportunity for professional development.
8. I have received appropriate support by the CCMS staff throughout my training.
9. CCMS Staff demonstrates an appreciation and understanding of individual differences (e.g. age, race/ethnicity, gender, sexual orientation, disability, socioeconomic status, religion/spirituality, etc.)
10. I would recommend CCMS to future students.

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* 6. Additional Comments

T