Dear Participant,
We are kindly requesting your time to complete this short evaluation form to provide feedback on your experiences during the one-week MDI Program. Your honest input will help us make the course more effective for future participants.
Thank you in advance for your time and feedback.

* 1. Your Name and Title

* 2. Your Organization

* 3. Please select the type of organization you work with:

* 4. Please rate the following program elements:

  1 [Lowest] 2 3 4 5 6 7 [Highest]
Program content/topics covered
CHIP process
Degree to which MDI raised your understanding of management and leadership
Degree to which MDI will influence the way you manage and lead

* 5. Please rate the usefulness of course materials:

  1 [Lowest] 2 3 4 5 6 7 [Highest]
Materials provided in advance
Materials provided on-site
CHIP workbook

* 6. Please rate the effectiveness of the Learning Group process:

  1 [Lowest] 2 3 4 5 6 7 [Highest]
Allows sufficient time to do required CHIP work
Helps me apply course concepts to my organization and my work
CHIP process
Supports peer networking
Overall effectiveness of the Learning Group

* 7. Please rate the effectiveness of your Teaching Associate:

  1 [Lowest] 2 3 4 5 6 7 [Highest]
Understands the theory and framework behind the CHIP
Provides constructive and helpful feedback on my CHIP
Involves participants in discussions (one-on-one or as a group) about the CHIP
Maintains an environment conducive to learning and working
Overall effectiveness of my TA in leading the Learning Group

* 8. Name of your TA

* 9. Please rate the quality of the facilities:

  1 [Lowest] 2 3 4 5 6 7 [Highest]
Comfort of meeting rooms
Comfort of sleeping rooms
Administrative support

* 10. Please rate the quality of the admissions process:

  1 [Lowest] 2 3 4 5 6 7 [Highest]
Application information requested
Submission process
Timing of notification

* 11. What is your preferred timing of notification of program acceptance?

* 12. Please rate your overall experience:

  1 [Lowest] 2 3 4 5 6 7 [Highest]
Satisfaction with your overall experience in the program
Likelihood to recommend the program to other leaders in the healthcare community.

* 13. What was the most valuable/important aspect of the program to you?

* 14. What would you recommend we do differently in the future?

* 15. Are there any additional comments or suggestions you would like to share?