edu
Subject: Fwd: Form submission from: KINS 3102: Preceptor Evaluation of Student
Date: October 11, 2017 at 11:01 PM
To: kayla.brockway@bobcats.gcsu.edu
INSTRUCTIONS
Please fill out the evaluation below. The survey will be emailed to the email address you provided on the survey. Please
printout the email. Both the student and preceptor need to sign and date the last page of the printout.
Student Name
Kayla Brockway
Preceptor Name
Caitlin Moeller
Preceptor Email
caitlin.moeller@gcsu.edu
Clinical Setting/Experience
GCSU RecSports
Date
October 11, 2017
Evaluation
Mid-term Evaluation
DIRECTIONS
Please evaluate the athletic training student objectively. Please select the appropriate response for each item in the categories
below. Select NA if you are not able to assess the student. NA = Not Able to Assess 5 = Outstanding 4 = Good 3 = Satisfactory
2 = Improvement Needed 1 = Unacceptable
NA 5 4 3 2 1
Interpersonal Skills
NA 5 4 3 2 1
Professional Responsibility
NA 5 4 3 2 1
1. Demonstrates punctuality. X
3. Demonstrates initiative. X
6. Maintains confidentiality. X
DIRECTIONS
Please evaluate the athletic training student objectively. Please select the appropriate response for each item in the categories
below. Select NA if you are not able to assess the student. NA = Not Able to Assess 5 = Outstanding 4 = Good 3 = Satisfactory
2 = Improvement Needed 1 = Unacceptable
Administrative Tasks
NA 5 4 3 2 1
1. Demonstrates an ability to multi-task efficiently and effectively. X
Technical Standards
NA 5 4 3 2 1
NA 5 4 3 2 1
NA 5 4 3 2 1
GLOBAL ASSESSMENT
In the space below, please assess the athletic training in each of the following areas:
Do you feel students under your supervision engage in a sufficient number of real-time clinical evaluations? Why or Why Not?
I do feel like they get enough real-time situations. I often let them begin an evaluation, especially if it is lower extremity, then fill in
the blanks. As the semester continues, there is more and more they can do.
Additional comments
I feel like Kayla is exactly where she should be at this point in her first semester. She is in attendance at every single opportunity
available, despite the busy-ness of the Volleyball schedule this year. Her work ethic and positive attitude stands out.
Signature
__________________________________________ Student Signature / Date