Residency Applicant Evaluation

Applicant Name:

Interviewer:

Full name

Interview Date:

Interview email:

I. Interest and aptitude for psychiatry:

1

2

3

4

5

6

7

8

9

10

Select 1 for Poor, 10 for Excellent

II. Ability to fit into our program:

1

2

3

4

5

6

7

8

9

10

Select 1 for Poor, 10 for Excellent

III. Social skills and ease during interview:

1

2

3

4

5

6

7

8

9

10

Select 1 for Poor, 10 for Excellent

Please describe any special problems or assets:

Global Evaluation:

Acceptable

Unacceptable

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