Please complete the following survey so that we can assess the viability of the experience and training you have received at your externship site.

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1. Student Name:

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2. Program (CNA, ASN, or BSN):

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3. Externship Site:

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4. Supervisor:

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5. Date (MM/DD/YY):

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6. Were you able to apply the school coursework to the externship workplace?

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7. Did the program training prepare you to use the externship site equipment?

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8. Did your supervisor explain your function as an extern?

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9. Were you provided an opportunity to interact with patients?

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10. Generally, does the supervisor and site display a positive attitude towards students?

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11. Did your externship experience complement and enhance your school training?

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12. What job duties did you perform while at the externship?

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13. What duties did you wish you had more time to work on?

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14. What area(s) should be improved or changed at the externship site that
would be helpful for students to get more applicable experience?

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15. Was the training you received applicable to the training activities you were asked to perform at the externship site?

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16. Overall Evaluation of Externship Experience (Please rate your overall externship experience)

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17. Would you recommend this site for future students?

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