Mansoura University

Faculty of Medicine

Elective Assessment Form

Re:

Dear Professor,

The Mansoura-Manchester Programme for Medical Education would like to thank you for
your kind supervision of the elective module to the above named student.

We would very much appreciate if you could complete the assessment form (below) and
send it in a sealed envelope (with the student) to the programme.

Poor Good Very good Excellent

<60% <75% <85% >85%
-Attendance

-Team Work

-Relationship with staff

and colleagues

-Relationship with
patients

-Overall performance

Mansoura Manchester Programme for Medical Education

E. Mail :Manchester@mans.edu.eg Tel.: +2050-2248963) Fax : +2050-2248203
 Mansoura University
Faculty of Medicine

,Best regards
,Supervisors Name, Programme Director

Signature Prof. Nagy A. H. Sayed Ahmed

Mansoura Manchester Programme for Medical Education

E. Mail :Manchester@mans.edu.eg Tel.: +2050-2248963) Fax : +2050-2248203