Stephen F. Austin State University
Richard and Lucille DeWitt School of Nursing
Student Evaluation of Clinical Agency
Form 40
Instructions: Please rate your clinical agency by using the following Likert Scale to answer the questions.
(5) Strongly agree (4) Agree (3) Neutral (2) Disagree (1) Strongly Disagree (0) Non-applicable
1. The staff related to me in a supportive manner.
2. The staff acted as a role model for professional nursing.
3. The agency and/or experience allowed for attention to my personal needs.
4. The agency was supportive of meeting objectives for a meaningful learning experience.
5. Comments on clinical agency
Committee: Evaluation: Forms: Forms: April, 2012
Reviewed May, 2013