Please rate your performance as a student based on the following measures.

Please reference the section titled Guide to Filling out Evaluations in the Student Preceptor Guidelines document found on the NCM website.

Feel free to add comments in the blank text boxes provided. It would be helpful to hear specifics about the ways in which you're achieving success so that we can garner wisdom from your accomplishments. Knowing about your struggles will also inform our ability to offer more targeted support to you in the areas where you are facing challenges.  If you feel the question does not entirely apply to your situation, please answer to the best of your ability and then explain in the text box what is unique about your situation. 

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* 1. Student Name

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* 2. Preceptor Name (please complete a separate evaluation for each of your preceptors)

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* 3. Date

Date

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* 5. I clearly identify and communicate to my preceptor my goals for learning.

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* 6. I have identified my learning style and am able to develop a strategy to match it.

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* 7. I identify and address any resistance or obstacles to my learning & I maximize my special talents.

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* 8. I am completing academic, clinical and skills requirements in a timely fashion.

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* 9. I identify and address issues/disagreements with my preceptor. I take the time to discuss the Student-Preceptor Evaluation results with my preceptor each trimester, take needed actions based on these evaluations, and ask for help from my community and/or NCM staff when issues arise that I am unable to address myself.

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* 10. I have sent the following forms to NCM for this trimester:

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* 11. Please evaluate NCM staff on the student services they provide, which include the following:
  • Credit transfers
  • Financial aid advisement, including NCM Scholarship Fund
  • Clinical placement support, including notifications on NCM’s online bulletin board
  • Academic advising for prospective and active students
  • New student orientation
  • Tutoring and Mentorship
  • Records Request
  • Counseling and Mediation
  • Career placement services, including information about NARM certification and state licensure requirements, credentials, practice, and/or employment opportunities listed on NCM’s online bulletin board
  • Support for students with disabilities and/or learning differences
  • Social support services linking academic and social integration for all students. Examples of social support services include keeping students connected by cohort and developing virtual or in-person learning communities.
  • Complaint process support
Please use the comment field to offer specific feedback.

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* 12. Please use the space provided to outline your goals for the upcoming trimester. This must match the goals outlined on the preceptor's evaluation form so please communicate with your preceptor before filling out this section.

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