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STUDENT EVALUATION FORM

Student Name: Supervisor: ? Butker ? Ferenci ? Elder ? Fox ? Ghavidel ? Howell ? Smith ? Sutter Date: Facility: ? TEC

? CLH

? Grady

? VA

? Other _____________________________________ Active Participation in Tasks


? Below Average Comments: ? Average ? Above Average

? Other _____________________________________ Effective Use of Time


? Below Average Comments: ? Average ? Above Average

Completion of Assigned Tasks


? Below Average Comments: ? Average ? Above Average

Proper and Careful Use of Equipment


? Below Average Comments: ? Average ? Above Average

Self-Motivation
? Below Average Comments: ? Average ? Above Average

Respect for Patients Right to Privacy


? Below Average Comments: ? Average ? Above Average

Cooperation
? Below Average Comments: ? Average ? Above Average

Grasp of Knowledge
? Below Average Comments: ? Average ? Above Average

Desire to Learn
? Below Average Comments: ? Average ? Above Average

Professional and Ethical Behavior


? Below Average Comments: ? Average ? Above Average

Preparedness
? Below Average Comments: ? Average ? Above Average

Professional Presentation
? Below Average Comments: ? Average ? Above Average

Points System: Below Average = 2 points Average = 3 points Above Average = 4 points

TOTAL:( _________ / 48)*100 = _________%

Supervisor Signature:____________________________________________ Date:_____________________

MEDICAL PHYSICS PROGRAM CLINICAL ROTATION COURSE

FORM A STUDENT EVAULATION FORM

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