Xavier University-Ateneo de Cagayan

COLLEGE OF NURSING
Corrales Avenue, Cagayan de Oro City

Practicing Clinical Instructor (PCI) Evaluation Form

PCI Name:
Rotation: SN Name (optional):
Hospital/Area:
Area ClinicaI Instructor:

Please rate and evaluate the following PCI with regards to the following criterion, kindly rate
using a (1-5) scale; 1 being the lowest and 5 the highest:

Knowledge:__/_5
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Skills:__/_5
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Attitude:__/_5
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Suggestions/Recommendations:
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