PRECEPTOR EVALUATION The student’s grade on the Practicum is based upon the quality of the student’s portfolio, the portfolio presentation, an overall assessment by the faculty, and your evaluation as the field preceptor. During the final week of the Practicum project, please complete this assessment and submit it directly to the Practicum Coordinator. Student/Practicum Information Student’s Name: ____________________________________________________________________________________ Practicum Title: ___________________________________________________________________________________ Preceptor/Site Information Name of Site: _____________________________________________________________________________________ Preceptor Name: _______________________________________ Phone: ____________________________________ Preceptor Title: ________________________________________ Email: _____________________________________ Learning Objectives At the beginning of the Practicum project, the student developed (and you signed) a Practicum Agreement that specified several learning objectives, the timeline associated with completing the objectives, how the objectives would be achieved, and what evidence would document the completion of the objectives. Referring to that document, please rate the degree to which each learning objective was achieved and provide comments about the quality of the student’s work. Comments on Quality Objective # Rating (select one)
Not Achieved Barely Achieved Achieved Not Achieved Barely Achieved Achieved Not Achieved Barely Achieved Achieved Not Achieved Barely Achieved Achieved Professional Qualities Indicate your assessment of the student’s professional qualities on a scale of 1-­‐5 (1=Low 5=High) by circling one number next to each statement below. Circle “NA” if you do not feel qualified to rate the item or if it does not apply. The student was … 1 2 3 4 5 NA Capable Reliable Professional Able to work well with others Functioned well as a team leader Accepted criticism well Sensitive to diversity Able to provide constructive feedback Able to effectively manage time Able to effectively express ideas/concepts in writing Knowledgeable Overall Evaluation of the Student Using the space below, please provide your overall evaluation of the student. Your Feedback We routinely make changes to the Practicum process to improve the experience for the students and our preceptors. Using the space below, please provide your feedback on this experience and note anything we can do better. Preceptor Signature: ________________________________________ Date: _________________________________ Thank you for serving as a field preceptor. Please send this form to the Practicum Coordinator: Kent State University publichealth@kent.edu College of Public Health www.kent.edu/publichealth Lowry Hall, 3rd Floor Fax: 330-­‐672-­‐6505 PO Box 5190 Tel: 330-­‐672-­‐6500 Kent, OH 44240