Interviewer Name:

Date of Interview:

Applicant Last Name:

Applicant First Name:

Mandatory Traits

Interpersonal Skills/Sense of Humor:

Kindness/Compassion:

Teaching Abilities:

Insight/Interest in OBGYN:

Behavioral Traits

Emotional maturity/Approach to deficiencies:

Challenging Situations:

Teamwork:

Gestalt Scores

Is this applicant a good fit for our residency program?

Is this applicant a good fit for OBGYN?

Comments: