General Information

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* 1. Student Name

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* 2. Which clinical experience are you completing this survey for?

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* 3. Were you notified of your site location at least 30 days prior to the start?

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* 4. Did you contact your assigned site prior to beginning to discuss policies, dress code, etc.?

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* 5. Name of Clinical Education Site

  Site:
Site Name:

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* 6. Clinical Experience Attendance

Date

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* 7. Clinical Experience Attendance

Date

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* 8. Primary Clinical Instructor Name

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* 9. What entry-level degree does your Primary Clinical Instructor have?

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* 10. Primary Clinical Instructor Years of Experience as a Clinician

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* 11. What area of expertise does your Primary Clinical Instructor have?

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* 12. What is your Primary Clinical Instructors Clinical Certification?

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* 13. Additional Clinical Instructor Name

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* 14. What entry-level degree does your Additional Clinical Instructor have?

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* 15. Additional Clinical Instructor Years of Experience as a Clinician

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* 16. What area of expertise does your Additional Clinical Instructor have?

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* 17. What is your Additional Clinical Instructors Clinical Certification?

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