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Subject: Fw: Form submission from: KINS 4112: Preceptor Evaluation of Student
Date: February 25, 2019 at 2:56 PM
To: kayla brockway kayla.brockway@bobcats.gcsu.edu
INSTRUCTIONS
Please fill out the evaluation below. The survey will be emailed to the email address you provided
on the survey. Please printout the email. Both the student and preceptor need to sign and date
on the survey. Please printout the email. Both the student and preceptor need to sign and date
the last page of the printout.
Student Name
Kayla Brockway
Preceptor Name
Amanda Windon
Preceptor Email
awindon23@gmail.com
Clinical Setting/Experience
Mount de Sales Academy
Date
February 25, 2019
Evaluation
Mid-term Evaluation
DIRECTIONS
Please evaluate the athletic training student objectively. Please select the appropriate response
for each item in the categories below. Select NA if you are not able to assess the student. NA =
Not Able to Assess 5 = Outstanding 4 = Good 3 = Satisfactory 2 = Improvement Needed 1 =
Unacceptable
NA 5 4 3 2 1
Interpersonal Skills
NA 5 4 3 2 1
Professional Responsibility
NA 5 4 3 2 1
1. Demonstrates punctuality. X
3. Demonstrates initiative. X
6. Maintains confidentiality. X
DIRECTIONS
Please evaluate the athletic training student objectively. Please select the appropriate response
for each item in the categories below. Select NA if you are not able to assess the student. NA =
Not Able to Assess 5 = Outstanding 4 = Good 3 = Satisfactory 2 = Improvement Needed 1 =
Not Able to Assess 5 = Outstanding 4 = Good 3 = Satisfactory 2 = Improvement Needed 1 =
Unacceptable
Administrative Tasks
NA 5 4 3 2 1
Technical Standards
NA 5 4 3 2 1
DIRECTIONS
Please evaluate the athletic training student objectively. Please select the appropriate response
for each item in the categories below. Select NA if you are not able to assess the student. NA =
Not Able to Assess 5 = Outstanding 4 = Good 3 = Satisfactory 2 = Improvement Needed 1 =
Unacceptable
NA 5 4 3 2 1
GLOBAL ASSESSMENT
In the space below, please assess the athletic training in each of the following areas:
Additional comments
I love her.
Do you feel students under your supervision engage in a sufficient number of real-time
clinical evaluations? Why or Why Not?
Yes. Because I have soft kids and they get 'hurt'.
Signature
__________________________________________ Student Signature / Date
https://intranet.gcsu.edu/node/1585/submission/15348