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Optional Evaluation of DPHB DEI/AR Faculty Development Activity
Along with each pre-approved DEI/AR activity determined to meet the faculty development requirement policy, there is an option to complete a short, anonymous survey to rate the quality of the experience. You are welcome to complete this form to provide us with feedback (or contact us directly), but this is not required. It is our hope that your input will help us cultivate enriching and relevant DEI/AR requirements over the years.
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Name of DEI/AR  Activity *
Date Activity was completed
MM
/
DD
/
YYYY
How would you rate this activity overall? *
Poor
Excellent
Please rate the activity by indicating your agreement with the following statements:
Communicated ideas and concepts effectively *
Made information relevant to clinical and/or research practice *
Made material relevant to your training and/or professional development *
Effectively addressed issues of diversity (such as related to age, gender, race/ethnicity, ability, sexual orientation, disability, or SES) *
Will your participation in this activity have an impact on your practice, leadership, performance, or research? *
Please explain your response to the previous question *
Speaker Evaluation:  The speaker provided information in an effective/interesting manner that facilitated my learning *
Poor
Excellent
Overall comments
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