Rotation-Specific Educational Objectives Form by ozo304


									                                           Office of Postgraduate Education  Centre for Addiction & Mental Health, College St. Site
                                           250 College Street, Suite 828 • Toronto ON M5T 1R9 • Canada  Tel: 416-979-6911 Fax: 416-979-6928 

                                       Research Elective Progress and Evaluation Report
                    (Report must be completed and submitted to the Post Grad Office at the end of each 6 month elective)
                                                 Please fax/e-mail completed Evaluation to:

Resident Name:                                                              PGY
                                                                                               Signature                                          Date
Program:         Clinician Scientist Program (CSP)         Non–CSS/CSP                 Will you be Continuing this Research Elective:                           Yes       No

Supervisor Name:
                                                                                               Signature                                          Date

Project Title:

PROGRESS REPORT – Resident to Complete: Please provide a brief report of the research activities in which you have been involved
over the last 6 months & describe your role and the progress achieved.

EVALUATION REPORT – Supervisor to Complete: Please provide a brief Evaluation of the Resident you are Supervising. Please
comment on their role, research activities and progress.

Departmental Review:
                            Dr. Ari Zaretsky, Director                          Date               Dr. Allan Kaplan, Vice-Chair (for Research applications only)          Date

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