COACH Program Evaluation Form
Dear COACH Program User:
Please take a few minutes to provide us with feedback about your experience(s) with the COACH Program.
The information you provide will assist us in making improvements to better serve our faculty.
Thank you!
Mitchell Charap, MD (Program Director)
Marian Anderson, MS, MA, RN (Program Manager)
Today’s Date:_____________
COACH Facilitator(s):_____________________
Date Matched with Facilitator: __________
Number of Meetings with Facilitator:____
Do you have an established mentoring committee?
Yes__ No__
Please rate each of the following program components:
1= Very Good
2=Good
3=Fair
4=Poor
A. Ease of Sign-up
1
2
3
4
B. Length of time to establish COACH Facilitator match
1
2
3
4
C. Satisfaction with COACH Facilitator match
1
2
3
4
1
2
3
2
3
4
D. Usefulness of meetings(s) with COACH Facilitator
4
E. Materials/Resources Available on COACH Website
1
What resources from the COACH website did you find most useful?
What resources would you use if these were available?
If you have an established mentoring committee and have also used the COACH Program, in what way(s) did
you use the program?
Your additional recommendations to improve the COACH Program: