SUPERVISOR
1) Organization:
yes( ) no( )
Outstanding( ) Good( ) Normal( ) Weak( ) Poor( )
2) Iniciative:
yes( ) no( )
Outstanding( ) Good( ) Normal( ) Weak( ) Poor( )
3) Criativity:
yes( ) no( )
Outstanding( ) Good( ) Normal( ) Weak( ) Poor( )
4) Performing tests of pre-course and post course knowledge of the students:
Pre: yes( ) no( )
Post: yes( ) no( )
Outstanding( ) Good( ) Normal( ) Weak( ) Poor( )
5) Course content:
Outstanding [complete]( ) Bom [between 50 and 75% complete]( ) Normal [50%complete]( )
Weak [25 to 49% [complete] ( ) Poor [<25%] ( )
6) Schedule Compliance:
yes( ) no( )
Outstanding( ) Good( ) Normal( ) Weak( ) Poor( )
7) Student didatics: (grade from 1 to 10) _______________________________________________
8) Student discussion after the class: (grade from 1 to 10) ________________________________
9) Fund-raising:
yes( ) no ( )
(grade from 1 to 10 based on the importance of the agencies) ______________________________
10) Number of the sponsors: ________ Total collected: ______________
11) New student attraction for its research line (tell the name and project): ______________________
12) Number of students in the course:
Graduation: ___ Improvement: ___ Graduation: _____
Plastic Surgeon: ____ Others: ___ Which one: _______
13) Student responsible by the course participation:
yes( ) no( )
Outstanding( ) Good( ) Normal( ) Weak( ) Poor( )
14) Attendance participation:
yes( ) no( )
Outstanding( ) Good( ) Normal( ) Weak( ) Poor( )
15) Suggestions: _____________________________________________________________________________
_______________________________________________________________________________________
STUDENT
1) Target public: ____________________________________________________________________________
2) Syllabus: insert the complete program and the menu of the program attached (objective, scientific importance....)
3) Number of participants: __________
4) Name of the participants: (attach the List of the registered students with all the personal data, including the address, e-mail....)
5) Registration Cost: _______________________________________________________________________
6) Theater: _________________________________________________________________________________
(Complete address)
7) Profissional responsible for the logistics of the event: ___________________ (attach names, complete address with CNPJ data...)
8) Certificate:
yes( ) no( )
Who made it: _______________________________
9) Disclosure:
yes( )no( )
Midia: Poster( ) folder( ) email( ) other( )
10) Number of times the disclosure was made: _______________
11) Number of each midia used to disclosure: ________________
12) Audio-visual resources:
Computer( ) Datashow( ) Slides projetor ( ) Overhead projetor( ) Other( ) Which one: _____________________
13) Coffee-break:
yes( ) no( )
Sponsor: yes( ) no( ) Which one: ______________________
14) Performing tests of pre-course and post course knowledge of the students:
Pre: yes( ) no( ) /
Post: yes( ) no( )
15) Professors attendance:
yes( ) no( )
Who: ______________________
16) Schedule compliance:
yes( ) no( )
17)Problems:
yes( ) no( )
Describe: ___________________
18) Number of students attending to the course:
Graduation: ___________ Improvement: ___
Graduation: ___ Plastic Surgery Expertise: _____ Other: ___ Which one: _____
19) Student attraction to its research line (insert names and projects): ______________________________________________
20) Self-evaluation from the student: (Grade from 1 to 10): __________________
21) Suggestions: ______________________________________________________________________________________________