Clinical Evaluation Form

Each year HPS students must submit a preceptor evaluation as part of the HPS requirements.  In this case, we consider a preceptor to be someone who supervises you as part of a clinical practicum or internship, someone for whom you work (if you are a paid, direct patient care provider), or someone you have regularly shadowed/observed.  The preceptor will evaluate the student's attitudes, behaviors, and performance in relation to health care practice.  This form may be completed online by the preceptor, or printed off and returned via mail, fax, email, or hand delivery.

 Please use the links below to access the Clinical Evaluation Form.  This link may be shared with your practitioner if s/he chooses to download the form independently or if s/he chooses to complete the form online.  If completed as a hard copy, this form may be emailed or mailed directly back to the HPS Committee (if the evaluator hopes for the responses to remain confidential), or given to the student to submit.  If an evaluator wishes for his/her responses to be kept confidential and has noted concerns/issues, the HPS Committee will work with the evaluator to provide appropriate feedback.  Generally, all feedback from evaluators will be shared with students unless the HPS Committee has been asked not to do so.

ONLINE Clinical Evaluation Form (This takes you to the online evaluation form that can be submitted directly to the HPS committee)

Clinical Evaluation Form (MS Word) (This is a Word document that can be printed and filled out by your preceptor)

Clinical Evaluation Form (PDF Fillable) (This is a PDF fillable document that can be printed and filled out by your preceptor)