Nutrition Dietetic Tech Supervised Practice Evaluation

Student's Name:

First NameLast Name

Internship Site:

Names of Preceptor(s):

Name of Primary Preceptor:

The person you spent the most time with.

Internship Course:

Provision of Learning Experiences:

Rows	Strongly Disagree	Disagree	Niether Disagree nor Agree	Agree	Strongly Agree	N/A
Effort was made by site to provide learning experiences to meet program objectives.
Effort was made by site to provide additional learning experiences or enhanced learning experiences.
Neither too much nor too little was expected of you in terms of your performance.
Learning experiences were well organized.
Learning experiences were meaningful and useful.
Adequate references and other materials were made available.

Comments for Provision of Learning Experiences:

Communication of Primary Preceptor:

Rows	Strongly Disagree	Disagree	Niether Disagree nor Agree	Agree	Strongly Agree	N/A
Preceptor was sensitive to situations, needs, feelings and attitudes.
Preceptor was supportive, encouraging and intellectually stimulating.
Preceptor encouraged participation and questions.
Preceptor was effective in communicating ideas and expectations.
Feedback from preceptor was regular, constructive and usable.
Evaluation conferences were beneficial, constructive and timely.

Comments for Communication of Primary Preceptor:

Communication of General Staff:

Rows	Strongly Disagree	Disagree	Niether Disagree nor Agree	Agree	Strongly Agree	N/A
Staff were supportive, encouraging and sensitive to students needs.
Staff encouraged participation and questions.
Staff helped provide atmosphere conducive to learning.

Comments for Communication of General Staff:

Knowledge and Enthusiasm of Preceptor:

Rows	Strongly Disagree	Disagree	Niether Disagree nor Agree	Agree	Strongly Agree	N/A
Preceptor was experienced and knowledgeable, relating theory and practice.
Preceptor was up-to-date on current developments in the profession of dietetics.
Preceptor appeared interested and enthusiastic about the profession of dietetics.

Comments for Knowledge and Enthusiasm of Preceptor:

Do you have suggestions or recommendations for future program planning in this rotation?

What helped you the most in this rotation?

Example: activities, preceptor feedback, etc. Please provide details.

What, if anything, hindered you from learning the most in this rotation?

Please verify that you are human:

Sender Name: