Clinical Extern Affiliate Survey

The following survey is being administered to seek your feedback and assess satisfaction relative to yourprogram training. The purpose is to collect data regarding a perception of a program’s strengths andweaknesses. Results of the surveys are to be shared with the administration, faculty, and advisory board.

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* 1. Today's Date:

Date

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* 2. Clinical Site Name:

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* 3. Program Name:

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* 4. Clinical Site Supervisor(Representative):

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* 5. Student(s) demonstrate acceptable knowledge and skills upon completion of their in-school training?

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* 6. Student(s) demonstrate an ability to perform their required tasks?

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* 7. How likely would you to hire a student upon graduation if there was an employment vacancy?

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* 8. The designated school representative remained in contact with your site providing any necessary support throughout the duration of the student’s (s’) externship experience?

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* 9. Please provide any comments relative to program strengths and/or weaknesses or any proposed program changes in the instructional activities for currently enrolled students:

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