PARTNERSHIP EVALUATION (Fiscal Year ______)
DFSR Tracking #_________ (Partnership Agreement)
1. TYPE: _______ Partnership Agreement _______Partnership Activity
2. FDA REGION/DISTRICT:
3. STATE/OTHER PARTNER:
4. PARTNERSHIP SUMMARY:
5. INCLUSIVE DATES: ________TO ________
6. RESOURCES:
7. OUTPUTS: (How many samples, number people trained, etc.)
8. OUTCOMES:(What was the result, benefit to partners, consumers?)
9. EVALUATION OF PARTNERSHIP AGREEMENT/ACTIVITY: (strengths/weakness,positives/negatives, goals met, etc.)
10. RECOMMENDATIONS:
11. ____ Annual Evaluation ____ Final Evaluation
12. RENEW PARTNERSHIP: ________YES ________NO
13. NEW PARTNERSHIP DATES: ________TO ________
14. Date of Meeting/Conference Call on evaluating Partnership
Agreement/Activity: __________________
15. Names of partners who participated in the evaluation
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
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