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Fields marked with a * are required.
* Your Name:
* Your Email:
* Your Rotation Course Number (ex. MED 486 or NURS 471):
* Start Date:
* End Date:
* Number of Patient Contacts:
* Site Name:
* Clinical site offered a range of patients with different presenting diagnoses.
* Clinical site provided care to patients of different areas.
* Clinical site accepted and incorporated me into daily activities.
* Clinical site offered experiences that were appropriate for my discipline and level of training.
* Clinical site was well suited as a training site for health professions students.
* General Comments:
* Provided sufficient information to orient me to the community.
* Provided a sufficient number of visits to support me while on this rotation.
* Provided resources (I.e. technology, library services, project resources) to help me meet the academic requirements for this rotation.
* AHEC student coordinator was accessible and helpful when needed.
* Housing was safe and within a reasonable distance from my clinical site.
* What Went Well?:
* What Could Be Improved?:
Preceptor 1
* Preceptor 1 Name:
* Preceptor 1 Discipline:
* Demonstrated a genuine interest in me.
* Answered my questions clearly.
* Allowed me to assume increasing levels of responsibility.
* Tailored teaching to my needs.
* Provided me with frequent feedback and evaluation.
* Was knowledgeable of the course requirements for this clinical experience from the syllabus.
Preceptor 2 (if applicable)
Preceptor 2 Name:
Preceptor 2 Discipline:
Demonstrated a genuine interest in me.
Answered my questions clearly.
Allowed me to assume increasing levels of responsibility.
Tailored teaching to my needs.
Provided me with frequent feedback and evaluation.
Was knowledgeable of the course requirements for this clinical experience from the syllabus.
General Comments:
Preceptor 3 (if applicable)
Preceptor 3 Name:
Preceptor 3 Discipline: