PTA - Student Survey of Clinical Preparedness (CE III)

Question Title

* 1. Please complete the below section with your personal information.

Name: *

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Email Address: *

Phone Number: *

Question Title

* 2. Please rate each area on a 1-5 scale on how prepared you felt you were for the clinical experience. The areas are based on the CPI evaluation. Mark N/A if Not Applicable.

Physical Therapy Services

	Strongly Disagree	Generally Disagree	Neutral (Adequate)	Generally Agree	Strongly Agree	N/A
Safety	Safety Strongly Disagree	Safety Generally Disagree	Safety Neutral (Adequate)	Safety Generally Agree	Safety Strongly Agree	Safety N/A
Clinical Behavior	Clinical Behavior Strongly Disagree	Clinical Behavior Generally Disagree	Clinical Behavior Neutral (Adequate)	Clinical Behavior Generally Agree	Clinical Behavior Strongly Agree	Clinical Behavior N/A
Accountability	Accountability Strongly Disagree	Accountability Generally Disagree	Accountability Neutral (Adequate)	Accountability Generally Agree	Accountability Strongly Agree	Accountability N/A
Cultural Competence	Cultural Competence Strongly Disagree	Cultural Competence Generally Disagree	Cultural Competence Neutral (Adequate)	Cultural Competence Generally Agree	Cultural Competence Strongly Agree	Cultural Competence N/A
Communication	Communication Strongly Disagree	Communication Generally Disagree	Communication Neutral (Adequate)	Communication Generally Agree	Communication Strongly Agree	Communication N/A
Self-Assessment and Lifelong Learning	Self-Assessment and Lifelong Learning Strongly Disagree	Self-Assessment and Lifelong Learning Generally Disagree	Self-Assessment and Lifelong Learning Neutral (Adequate)	Self-Assessment and Lifelong Learning Generally Agree	Self-Assessment and Lifelong Learning Strongly Agree	Self-Assessment and Lifelong Learning N/A
Clinical Problem Solving	Clinical Problem Solving Strongly Disagree	Clinical Problem Solving Generally Disagree	Clinical Problem Solving Neutral (Adequate)	Clinical Problem Solving Generally Agree	Clinical Problem Solving Strongly Agree	Clinical Problem Solving N/A