Interdepartmental
Graduate Concentration
in Survey Research Methodology
STUDENT’S EVALUATION OF PRACTICUM (PA-579) OFF CAMPUS
Semester ____________ Year _______ Credit Hours _____
Student’s name _________________________________________________ UIN _____________________
UIC campus address ________________________________________ UIC e-mail __________________
Practicum site name ________________________________________ City/State ______________________
Preceptor’s name __________________________________________ Title ___________________________
Start Date: _____________________ End Date: _____________________ Average hours/week: _________
Your evaluation will be kept confidential from your preceptor and other staff at your practicum site.
Please circle the number that corresponds to your response to each of the following questions.
How much did this practicum experience …
Not at All
Very Much
1. Contribute to your knowledge of survey research methodology? .....
1
2
3
4
5
2. Contribute to your skills in survey research methodology? ...............
1
2
3
4
5
3. Provide opportunities to be exposed to day-to-day
aspects of survey research practice? ................................................
1
2
3
4
5
4. Enable you to achieve all of your learning objectives? ......................
1
2
3
4
5
5. Challenge you to work at your highest level of your ability? ..............
1
2
3
4
5
6. Contribute to your specific career interests? .....................................
1
2
3
4
5
How much was your preceptor …
Not at All
Very Much
7. Accessible to you? .............................................................................
1
2
3
4
5
8. Interested in helping you achieve all of your learning objectives? ....
1
2
3
4
5
9. Effective in helping you achieve all of your learning objectives? .......
1
2
3
4
5
10. Experienced in relevant aspects of survey
research methodology? .....................................................................
1
2
3
4
5
GCSRM 8/07
2
11. Overall, how do you rate this practicum experience?
Poor
1
Excellent
2
3
4
5
12. Do you recommend this practicum site to other GCSRM students for a practicum experience?
Yes .............................................
1
No ...............................................
2
13. Do you recommend your practicum preceptor to other GCSRM students for a practicum experience?
Yes .............................................
1
No ...............................................
2
14. In the space below, please enter your comments about your practicum experience, regarding the site and/or
preceptor.
Signature ____________________________________________________
Date
_________________
Submit original form to:
Allyson Holbrook, PhD, Co-Director
140 CUPPA Hall, M/C 336
or
Frederick J. Kviz, PhD, Co-Director
645 SPHPI, M/C 923
GCSRM 8/07