Site Supervisor Final Review Form | Health Sciences Clinical Education

Site Supervisor Name

Prefix First Last Suffix

Title

Email

Student Name

First Last

Hours Completed On-Site

Student Evaluation

Is reliable

Is punctual

Takes initiative

Completes projects in a timely manner

Demonstrates good judgement

Has strong organizational skills

Works well in a team

Works independently, without much direction

Accepts feedback

Communicates well with supervisor

Demonstrates professional conduct

Demonstrates mastery of learning objectives

To what extent did the student's work contribute to the mission of your agency/organization?

Additional Comments (you may provide more information about the student, and/or feedback about any aspect of the required Practicum Program):

Student Grade*

Please indicate the grade you would give to this student for their work with you this semester. This will be factored in to the overall grade for the course.

Signature

Printing Name here acts as signature for this form.

Name

First Last