2014-2015 COMMITTEE EVALUATIONS
  
 
 
 
 
 
Your Name:*
 
 
 
 
 
Committee Name*
 
 
 
 
 
What is your position on the committee/subcommittee?*
 
Chair
Sub-Committee Chair
Member
Board Liasion
Staff Liaison
Chapter Executive
EMRA Representative
 
 
 
 
Please select the response that best describes your impression. The committee/subcommittee is working effectively to accomplish the assigned objectives.*
 
Yes
No
 
 
 
 
If no, please explain.
 
 
 
 
 
I wish to be reappointed to the committee/subcommittee:*
 
Yes
No
 
 
 
 
Comments:
 
 
 
 
 
I wish to be considered as a potential committee/subcommittee chair or reappointed as a committee/subcommittee chair:*
 
Yes
No
 
 
 
 
During the next committee year, I would also like to be considered for appointment to the _______ committee/subcommittee. (Please submit current CV to mfletcher@acep.org)
 
 
 
 
 
Please provide your suggestions for potential committee objectives for the next committee year.
 
 
 
 
 
This question is for completion by CHAIRS only. Please share your thoughts about your staff liaison, board liaison, or any individual members of the committee/subcommittee. Do you have any areas of concern or comments about any extraordinary accomplishments?
 
 
 
 
 
This question is for completion by ACEP STAFF LIAISON only. Please share your thoughts about your chair, board liaison, or any individual members of the committee/subcommittee. Do you have any areas of concern or comments about any extraordinary accomplishments?
 
 
 
 
 
This question is for completion by BOARD LIAISONS only. Please share your thoughts about your chair. Do you have any areas of concern or comments about any extraordinary accomplishments?
 
 
 
 
 
This question is for completion by COMMITTEE MEMBERS only. Please share your thoughts about your committee/subcommittee chair. Do you have any areas of concern or comments about any extraordinary accomplishments?
 
 
 
 
 
This question is for completion by EMRA member(s) serving as the appointed representatives to the committees. Please share your thoughts about your staff liaison, board liaison, or any individual members of the committee/subcommittee. Do you have any areas of concern or comments about any extraordinary accomplishments?
 
 
 
 
  
2014-2015 COMMITTEE EVALUATIONS
 
If you serve on a second committee, please complete the following.

If you only serve one committee, click next to skip this section.  
 
 
 
Do you serve on a 2nd committee?
 
Yes
No
 
 
 
 
Please select the 2nd Committee Name
 
 
 
 
 
What is your position on the committee/subcommittee
 
Chair
Sub-committee Chair
Member
Board Liaison
Staff Liaison
Chapter Executive
EMRA Representative
 
 
 
 
Please select the response that best describes your impression. The committee/subcommittee is working effectively to accomplish the assigned objectives.
 
Yes
No
 
 
 
 
If no, please explain.
 
 
 
 
 
I wish to be reappointed to the committee/subcommittee:
 
Yes
No
 
 
 
 
Comments:
 
 
 
 
 
I wish to be considered as a potential committee/subcommittee chair or reappointed as a committee/subcommittee chair:
 
Yes
No
 
 
 
 
During the next committee year, I would also like to be considered for appointment to the ______ committee/subcommittee. (Please submit current CV to mfletcher@acep.org).
 
 
 
 
 
Please provide your suggestions for potential committee objectives for the next committee year.
 
 
 
 
 
This question is for completion by CHAIRS only. Please share your thoughts about your staff liaison,
board liaison, or any individual members of the committee/subcommittee. Do you have any areas of
concern or comments about any extraordinary accomplishments?
 
 
 
 
 
This question is for completion by ACEP STAFF LIAISON only. Please share your thoughts about your
chair, board liaison, or any individual members of the committee/subcommittee. Do you have any
areas of concern or comments about any extraordinary accomplishments?
 
 
 
 
 
This question is for completion by BOARD LIAISONS only. Please share your thoughts about your chair. Do you have any areas of concern or comments about any extraordinary accomplishments?
 
 
 
 
 
This question is for completion by COMMITTEE MEMBERS only. Please share your thoughts about your committee/subcommittee chair. Do you have any areas of concern or comments about any extraordinary accomplishments?
 
 
 
 
 
This question is for completion by EMRA member(s) serving as the appointed representatives to the committees. Please share your thoughts about your staff liaison, board liaison, or any individual members of the committee/subcommittee. Do you have any areas of concern or comments about any extraordinary accomplishments?
 
 
 
 
 
 
 
  
2014-2015 COMMITTEE EVALUATIONS
 
If you serve on a third committee, please complete the following.

If you only serve one committee, click next to skip this section.  
 
 
 
Do you serve on a 3rd committee
 
Yes
No
 
 
 
 
Please select the 3rd Committee Name
 
 
 
 
 
What is your position on the committee/subcommittee?
 
Chair
Sub-committee Chair
Member
Board Liaison
Staff Liaison
Chapter Executive
EMRA Representative
 
 
 
 
Please select the response that best describes your impression. The committee/subcommittee is working effectively to accomplish the assigned objectives.
 
Yes
No
 
 
 
 
If no, please explain.
 
 
 
 
 
I wish to be reappointed to the committee/subcommittee:
 
Yes
No
 
 
 
 
Comments:
 
 
 
 
 
I wish to be considered as a potential committee/subcommittee chair or reappointed as a committee/subcommittee chair:
 
Yes
No
 
 
 
 
During the next committee year, I would also like to be considered for appointment to the ______ committee/subcommittee. (Please submit current CV to mfletcher@acep.org).
 
 
 
 
 
Please provide your suggestions for potential committee objectives for the next committee year.
 
 
 
 
 
This question is for completion by CHAIRS only. Please share your thoughts about your staff liaison, board liaison, or any individual members of the committee/subcommittee. Do you have any areas of concern or comments about any extraordinary accomplishments?
 
 
 
 
 
This question is for completion by ACEP STAFF LIAISON only. Please share your thoughts about your chair, board liaison, or any individual members of the committee/subcommittee. Do you have any areas of concern or comments about any extraordinary accomplishments?
 
 
 
 
 
This question is for completion by BOARD LIAISONS only. Please share your thoughts about your chair. Do you have any areas of concern or comments about any extraordinary accomplishments?
 
 
 
 
 
This question is for completion by COMMITTEE MEMBERS only. Please share your thoughts about your committee/subcommittee chair. Do you have any areas of concern or comments about any extraordinary accomplishments?
 
 
 
 
 
This question is for completion by EMRA member(s) serving as the appointed representatives to the committees. Please share your thoughts about your staff liaison, board liaison, or any individual members of the committee/subcommittee. Do you have any areas of concern or comments about any extraordinary accomplishments?
 
 
 
 
 
 
 
  
2014-2015 COMMITTEE EVALUATIONS
 
If you serve on a fourth committee, please complete the following.

If you only serve one committee, click next to skip this section.  
 
 
 
Do you serve on a 4th committee?
 
Yes
No
 
 
 
 
Please select the 4th Committee Name
 
 
 
 
 
What is your position on the committee/subcommittee?
 
Chair
Sub-Committtee Chair
Member
Board Liaison
Staff Liaison
Chapter Executive
EMRA Representative
 
 
 
 
Please select the response that best describes your impression. The committee/subcommittee is working effectively to accomplish the assigned objectives.
 
Yes
No
 
 
 
 
If no, please explain.
 
 
 
 
 
I wish to be reappointed to the committee/subcommittee:
 
Yes
No
 
 
 
 
Comments:
 
 
 
 
 
I wish to be considered as a potential committee/subcommittee chair or reappointed as a committee/subcommittee chair:
 
Yes
No
 
 
 
 
During the next committee year, I would also like to be considered for appointment to the ______ committee/subcommittee. (Please submit current CV to mfletcher@acep.org).
 
 
 
 
 
Please provide your suggestions for potential committee objectives for the next committee year.
 
 
 
 
 
This question is for completion by CHAIRS only. Please share your thoughts about your staff liaison, board liaison, or any individual members of the committee/subcommittee. Do you have any areas of concern or comments about any extraordinary accomplishments?
 
 
 
 
 
This question is for completion by ACEP STAFF LIAISON only. Please share your thoughts about your chair, board liaison, or any individual members of the committee/subcommittee. Do you have any areas of concern or comments about any extraordinary accomplishments?
 
 
 
 
 
This question is for completion by BOARD LIAISONS only. Please share your thoughts about your chair. Do you have any areas of concern or comments about any extraordinary accomplishments?
 
 
 
 
 
This question is for completion by COMMITTEE MEMBERS only. Please share your thoughts about your committee/subcommittee chair. Do you have any areas of concern or comments about any extraordinary accomplishments?
 
 
 
 
 
This question is for completion by EMRA member(s) serving as the appointed representatives to the committees. Please share your thoughts about your staff liaison, board liaison, or any individual members of the committee/subcommittee. Do you have any areas of concern or comments about any extraordinary accomplishments?
 
 
 
 
 
 
 
 
  
2014-2015 COMMITTEE EVALUATIONS
 
Congratulations you have completed the 2014-2015Committee Evaluation. 

Your input is very important to the committee process. Thank you for taking the time to complete this evaluation.

Please enter your email address then click finish to submit your evaluation. 
 
 
 
Email*