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Residency Evaluation Form

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Residency Evaluation Form

Preceptor Guidebook (PDF)

For Faculty and Staff

At the completion of the summer residency, please complete and submit this form bu October 12, 2007 to Amy Thaci, Director of Professional Development, OSU MHA Program. If you have questions, you can contact Amy at thaci.1@osu.edu or (614) 292-0969.

General Information Student Name:
Today's Date:
Preceptor Name:
Title:
Organization:
Preceptor's Phone #:
Preceptor's E-Mail:
Address:

Please describe the student's main roles and responsibilities:

What were the student's major strengths in the residency?

In what areas could the student function more effectively?

What new skills did the student develop as a result of the residency?

Did the student maintain a positive attitude? Always Most of the time Some of the time

Did the student maintain a professional demeanor? Always Most of the time Some of the time

How well was the residency suited to the student's ability and interests? Well-suited Satisfactorily suited Not well suited

Please Explain:

What is your overall evaluation of the student's performance? Excellent Good Satisfactory Needs Improvement Unsatisfactory

Please enter any additional comments:

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