• Decrease font size
  • Return font size to normal
  • Increase font size
U.S. Department of Health and Human Services

For Federal, State, Local, Tribal, and Territorial Officials

  • Print
  • Share
  • E-mail

Appendix E: Partnership Evaluation Form

Table of Contents     

Previous Topic   Next Topic

 

 Partnership Agreements

Appendix E: Partnership Evaluation Form

Revised Form

PARTNERSHIP EVALUATION (Fiscal Year ______)

DFSR Tracking #_________ (Partnership Agreement)


1. TYPE:  _______ Partnership Agreement _______Partnership Activity

2. FDA REGION/DISTRICT:

3. STATE/OTHER PARTNER:

4. PARTNERSHIP SUMMARY:

 

 

 

 

5. INCLUSIVE DATES:    ________TO ________

6. RESOURCES:

 

 

7. OUTPUTS: (How many samples, number people trained, etc.)

 

 

 

 

8. OUTCOMES:(What was the result, benefit to partners, consumers?)

 

 

 

 

 

9. EVALUATION OF PARTNERSHIP AGREEMENT/ACTIVITY: (strengths/weakness,positives/negatives, goals met, etc.)

 

 

 

 

 

10. RECOMMENDATIONS:

 

 

 

 

 

11. ____ Annual Evaluation ____ Final Evaluation

 

 

12. RENEW PARTNERSHIP: ________YES ________NO

 

 

13. NEW PARTNERSHIP DATES: ________TO ________

 

 

 

14. Date of Meeting/Conference Call on evaluating Partnership

Agreement/Activity: __________________

 

 

 

 

15. Names of partners who participated in the evaluation

_______________________________________________

_______________________________________________

_______________________________________________

_______________________________________________

_______________________________________________

_______________________________________________

_______________________________________________

 

Previous Topic                                                          Next Topic