Evaluation Committee |

Committee Name *

Committee Members

Evaluation Period Start *

Evaluation Period End *

Committee Chair Name

Affiliation

Chair Start Date

Achieving Objectives (Max: 20)

Implementing Plan (Max: 20)

Average Member Score ÷ 2 (Max: 50)

Executive Chair Score (Max: 10)

Total Skills Score / 100

Result/Skill

Score

Distinctive Results Total

Final Total Score

Recommendation from Chair of Assembly

Evaluation Date *

Evaluator Name *

Signature File (Optional) Accepted formats: JPG, PNG, PDF (Max 2MB)