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Chair of Ophthalmology and Director, Flaum Eye Institute - (DiLoreto)

David DiLoreto, M.D.

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* 1. Your Name (Optional)

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* 2. Your Affiliation

Faculty

Staff

Trainee

Other (please specify)

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* 3. Please indicate the following:

I met with the candidate individually.

I met with the candidate individually AND attended a Town Hall.

I only attended a Town Hall.

Other (please specify)

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* 4. Please evaluate the candidate's abilities in each of the following domains:

	Above Average	Average	Fair	Poor	Cannot Assess
Professionalism (Candidate's professional appearance, demeanor, and manner)	Professionalism (Candidate's professional appearance, demeanor, and manner) Above Average	Professionalism (Candidate's professional appearance, demeanor, and manner) Average	Professionalism (Candidate's professional appearance, demeanor, and manner) Fair	Professionalism (Candidate's professional appearance, demeanor, and manner) Poor	Professionalism (Candidate's professional appearance, demeanor, and manner) Cannot Assess
Candidate Enthusiasm (Did the candidate come prepared/knowledgeable about the position and actively demonstrate serious interest?)	Candidate Enthusiasm (Did the candidate come prepared/knowledgeable about the position and actively demonstrate serious interest?) Above Average	Candidate Enthusiasm (Did the candidate come prepared/knowledgeable about the position and actively demonstrate serious interest?) Average	Candidate Enthusiasm (Did the candidate come prepared/knowledgeable about the position and actively demonstrate serious interest?) Fair	Candidate Enthusiasm (Did the candidate come prepared/knowledgeable about the position and actively demonstrate serious interest?) Poor	Candidate Enthusiasm (Did the candidate come prepared/knowledgeable about the position and actively demonstrate serious interest?) Cannot Assess
Clinical Leadership Potential (How effectively will the candidate lead the continued growth and ensure the quality excellence of the clinical mission of the Department/Institute?)	Clinical Leadership Potential (How effectively will the candidate lead the continued growth and ensure the quality excellence of the clinical mission of the Department/Institute?) Above Average	Clinical Leadership Potential (How effectively will the candidate lead the continued growth and ensure the quality excellence of the clinical mission of the Department/Institute?) Average	Clinical Leadership Potential (How effectively will the candidate lead the continued growth and ensure the quality excellence of the clinical mission of the Department/Institute?) Fair	Clinical Leadership Potential (How effectively will the candidate lead the continued growth and ensure the quality excellence of the clinical mission of the Department/Institute?) Poor	Clinical Leadership Potential (How effectively will the candidate lead the continued growth and ensure the quality excellence of the clinical mission of the Department/Institute?) Cannot Assess
Academic Leadership Potential (How effectively will the candidate lead the academic mission of the Department and further the institution's goals in growth of research?)	Academic Leadership Potential (How effectively will the candidate lead the academic mission of the Department and further the institution's goals in growth of research?) Above Average	Academic Leadership Potential (How effectively will the candidate lead the academic mission of the Department and further the institution's goals in growth of research?) Average	Academic Leadership Potential (How effectively will the candidate lead the academic mission of the Department and further the institution's goals in growth of research?) Fair	Academic Leadership Potential (How effectively will the candidate lead the academic mission of the Department and further the institution's goals in growth of research?) Poor	Academic Leadership Potential (How effectively will the candidate lead the academic mission of the Department and further the institution's goals in growth of research?) Cannot Assess
Educational Leadership Potential (How effectively will the candidate lead the educational mission of the Department including promoting excellence in the learning environment?)	Educational Leadership Potential (How effectively will the candidate lead the educational mission of the Department including promoting excellence in the learning environment?) Above Average	Educational Leadership Potential (How effectively will the candidate lead the educational mission of the Department including promoting excellence in the learning environment?) Average	Educational Leadership Potential (How effectively will the candidate lead the educational mission of the Department including promoting excellence in the learning environment?) Fair	Educational Leadership Potential (How effectively will the candidate lead the educational mission of the Department including promoting excellence in the learning environment?) Poor	Educational Leadership Potential (How effectively will the candidate lead the educational mission of the Department including promoting excellence in the learning environment?) Cannot Assess
Faculty Development Leadership Potential (How effectively will the candidate be able to lead efforts to promote faculty development, including recruitment, retention, promotion and diversity?)	Faculty Development Leadership Potential (How effectively will the candidate be able to lead efforts to promote faculty development, including recruitment, retention, promotion and diversity?) Above Average	Faculty Development Leadership Potential (How effectively will the candidate be able to lead efforts to promote faculty development, including recruitment, retention, promotion and diversity?) Average	Faculty Development Leadership Potential (How effectively will the candidate be able to lead efforts to promote faculty development, including recruitment, retention, promotion and diversity?) Fair	Faculty Development Leadership Potential (How effectively will the candidate be able to lead efforts to promote faculty development, including recruitment, retention, promotion and diversity?) Poor	Faculty Development Leadership Potential (How effectively will the candidate be able to lead efforts to promote faculty development, including recruitment, retention, promotion and diversity?) Cannot Assess
Financial Literacy and Leadership Potential (How well does the candidate grasp the financial oversight required for the Department, and demonstrate the ability to lead the Department with fiscal responsibility?)	Financial Literacy and Leadership Potential (How well does the candidate grasp the financial oversight required for the Department, and demonstrate the ability to lead the Department with fiscal responsibility?) Above Average	Financial Literacy and Leadership Potential (How well does the candidate grasp the financial oversight required for the Department, and demonstrate the ability to lead the Department with fiscal responsibility?) Average	Financial Literacy and Leadership Potential (How well does the candidate grasp the financial oversight required for the Department, and demonstrate the ability to lead the Department with fiscal responsibility?) Fair	Financial Literacy and Leadership Potential (How well does the candidate grasp the financial oversight required for the Department, and demonstrate the ability to lead the Department with fiscal responsibility?) Poor	Financial Literacy and Leadership Potential (How well does the candidate grasp the financial oversight required for the Department, and demonstrate the ability to lead the Department with fiscal responsibility?) Cannot Assess
Departmental and Institutional Compatibility (Without reference to any group characteristic (age, gender, race, national origin) how well would the candidate "fit" with the cultural environment of the Department and Institution?)	Departmental and Institutional Compatibility (Without reference to any group characteristic (age, gender, race, national origin) how well would the candidate "fit" with the cultural environment of the Department and Institution?) Above Average	Departmental and Institutional Compatibility (Without reference to any group characteristic (age, gender, race, national origin) how well would the candidate "fit" with the cultural environment of the Department and Institution?) Average	Departmental and Institutional Compatibility (Without reference to any group characteristic (age, gender, race, national origin) how well would the candidate "fit" with the cultural environment of the Department and Institution?) Fair	Departmental and Institutional Compatibility (Without reference to any group characteristic (age, gender, race, national origin) how well would the candidate "fit" with the cultural environment of the Department and Institution?) Poor	Departmental and Institutional Compatibility (Without reference to any group characteristic (age, gender, race, national origin) how well would the candidate "fit" with the cultural environment of the Department and Institution?) Cannot Assess

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* 5. How do you rate this candidate's Interpersonal Skills?

	Above Average	Average	Fair	Poor	Cannot assess
Active Listener	Active Listener Above Average	Active Listener Average	Active Listener Fair	Active Listener Poor	Active Listener Cannot assess
Inspirational/Motivational	Inspirational/Motivational Above Average	Inspirational/Motivational Average	Inspirational/Motivational Fair	Inspirational/Motivational Poor	Inspirational/Motivational Cannot assess
Passion/Energy	Passion/Energy Above Average	Passion/Energy Average	Passion/Energy Fair	Passion/Energy Poor	Passion/Energy Cannot assess
Communication and Articulation	Communication and Articulation Above Average	Communication and Articulation Average	Communication and Articulation Fair	Communication and Articulation Poor	Communication and Articulation Cannot assess
Integrity & Trust	Integrity & Trust Above Average	Integrity & Trust Average	Integrity & Trust Fair	Integrity & Trust Poor	Integrity & Trust Cannot assess
Confidence/Composure	Confidence/Composure Above Average	Confidence/Composure Average	Confidence/Composure Fair	Confidence/Composure Poor	Confidence/Composure Cannot assess
Humility/Self Awareness	Humility/Self Awareness Above Average	Humility/Self Awareness Average	Humility/Self Awareness Fair	Humility/Self Awareness Poor	Humility/Self Awareness Cannot assess

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* 6. What positive qualities do you feel this candidate possesses for this role?

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* 7. What, if any, are your concerns about this candidate's qualifications?

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* 8. What is your overall assessment of the candidate for the Chair of Ophthalmology and Director, Flaum Eye Institute?

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* 9. Should this candidate be considered further?

Yes

No