Other comments and/or recommendations:

Answer length:00 (Max: 2048)

* - Required

Page 5 of 5 Voting & Surveys - Athletic Training Student Clinical Experience Evaluation (UNI ACI's)

Athletic Training Student Clinical Experience Evaluation (AT CI's)

Please evaluate each athletic training student assigned to you this past rotation. Your superving ACI should be present when completing these evaluations.

Page 1 1 / 2

1) Your name:*

Answer length:00 (Max: 2048)

2) Select the student you are evaluating.*

3) During this rotation, has there ever been a situation when you were unable to directly supervise this student? (If

Yes, you will be sent to page 2.)*

Please select

4) OVERALL GRADE

Based on the following scale, identify the student's overall grade for this rotation. (Note: This grade will be incorporated into the student's Practicum grade for the semester)*

Identify Grade

A=Performing above the expected level (competence, initiative, interpersonal communications, etc.)

B=Performing at the appropriate level as is expected.

C=Performing adequately, slightly below expected level.

D=Performing well below expected level as a student.

F=Failed to display competence, should repeat experience.

5) Personal Attributes

Based on the following scale, identify the athletic training student's performance for each personal attribute listed. *Excellent (5): the attribute is effectively demonstrated 80%-100% of the time.

*Above average (4): the attribute is effectively demonstrated 60%-80% of the time. *Average (3): the attribute is effectively demonstrated 40%-60% of the time. *Below average (2): the attribute is effectively demonstrated 20%-40% of the time. *Poor (1): the attribute is demonstrated less than 20% of the time.*

Page 1 of 6 Voting & Surveys - Athletic Training Student Clinical Experience Evaluation (AT CI's)

Poor Below Average Average Above Average Excellent N/A Attitude/Demeanor Enthusiasm Preparation Reliability Emotional maturity Initiative Cooperation Judgement/Attention to risk Personal appearance Punctuality Professionalism

Professional relationship with athletes/patients

Professional relationship with coaches

Professional relationship with ACI

Professional relationship with peers

Professional relationship with other health care professionals

Professional relationship with administration

Ability to accept constructive criticism

Page 2 of 6 Voting & Surveys - Athletic Training Student Clinical Experience Evaluation (AT CI's)

Leadership qualities

Awareness

Dependability

Work ethic

6) Comments for Personal Attributes (please comment on any ranking of 1 or 2):

Answer length:00 (Max: 2048)

7) Professional Attributes

Based on the following scale and on the athletic training student's competency level (1st, 2nd, 3rd year student), identify the student's performance for each professional attribute listed.

*Excellent (5): the attribute is effectively demonstrated 80%-100% of the time. *Above average (4): the attribute is effectively demonstrated 60%-80% of the time. *Average (3): the attribute is effectively demonstrated 40%-60% of the time. *Below average (2): the attribute is effectively demonstrated 20%-40% of the time. *Poor (1): the attribute is demonstrated less than 20% of the time.*

Poor Below Average Average Above Average Excellent N/A

Demonstrates confidence when practicing athletic training

Makes proper conclusions and decisions

Able to effectively communicate

Shows creativity within competency level

Demonstrates critical thinking

Demonstrates problem solving

Recognition of strengths and limitations

Uses equipment and resources appropriately

Page 3 of 6 Voting & Surveys - Athletic Training Student Clinical Experience Evaluation (AT CI's)

Seeks advice for improvement

8) Comments for Professional Attributes (please comment on any ranking of 1 or 2):

Answer length:00 (Max: 2048)

9) Athletic Training Competency

Based on the following scale and on the athletic training student's competency level (1st, 2nd, 3rd year student), identify the student's performance for each area of clinical proficiency listed.

*Excellent (5): the student demonstrates knowledge and skills consistent for the entry-level athletic training practitioner.

*Above Average (4): the student demonstrates knowledge and skills consistent for the 2nd year athletic training student.

*Average (3): the student demonstrates knowledge and skills consistent for the 1st year athletic training student. *Below Average (2): the student demonstrates knowledge and skills consistent noticeably below his/her competency level.

*Poor (1): the student completely fails to demonstrate any knowledge or skills in this area.*

Poor Below Average Average Above Average Excellent N/A

General athletic training proficiency

Taping and bandaging

Wound care

Emergency care

General anatomy and physiology proficiency

Injury/illness etiology and pathology

Lower extremity injury assessment

Upper extremity injury assessment

Trunk and spine injury assessment

Kinesiological evaluations

Page 4 of 6 Voting & Surveys - Athletic Training Student Clinical Experience Evaluation (AT CI's)

General organization and administration proficiency

General pharmacological proficiency

General nutrition proficiency

Therapeutic modalities

Rehabilitation and therapeutic exercise

10) Comments for Athletic Training Competency (please comment on all areas of considerable weakness; all rankings of 1 or 2 require a written comment):

Answer length:00 (Max: 2048)

11) Given the student's level of competency and the goals/objectives of this clinical experience, identify the strengths of the student.*

Answer length:00 (Max: 2048)

12) Given the student's level of competency and the goals/objectives of this clinical experience, identify the areas needing improvement for the student.*

Answer length:00 (Max: 2048)

13) Other comments and/or recommendations:

Answer length:00 (Max: 2048)

* Required

Page 5 of 6 Voting & Surveys - Athletic Training Student Clinical Experience Evaluation (AT CI's)

Athletic Training Student Clinical Experience Evaluation (non-AT CI's)

Please evaluate each athletic training student assigned to you this past rotation.

Page 1

1) Your name:*

Answer length:00 (Max: 2048)

2) Select the student you are evaluating.*

3) OVERALL GRADE

Based on the following scale, identify the student's overall grade for this rotation. (Note: This grade will be incorporated into the student's Practicum grade for the semester)*

Identify Grade A=Performing above the expected level (competence, initiative, interpersonal communications, etc.)

B=Performing at the appropriate level as is expected. C=Performing adequately, slightly below expected level. D=Performing well below expected level as a student. F=Failed to display competence, should repeat experience.

4) Personal Attributes

Based on the following scale, identify the athletic training student's performance for each personal attribute listed. *Excellent (5): the attribute is effectively demonstrated 80%-100% of the time.

*Above average (4): the attribute is effectively demonstrated 60%-80% of the time. *Average (3): the attribute is effectively demonstrated 40%-60% of the time. *Below average (2): the attribute is effectively demonstrated 20%-40% of the time. *Poor (1): the attribute is demonstrated less than 20% of the time.*

Poor Below Average Average Above Average Excellent N/A Attitude/Demeanor

Enthusiasm

Page 1 of 4 Voting & Surveys - Athletic Training Student Clinical Experience Evaluation (UNI S&C ...

Preparation Reliability Emotional maturity Initiative Cooperation Judgement/Attention to risk Personal appearance Punctuality Professionalism

Professional relationship with athletes/patients Professional relationship with coaches Professional relationship with CI Professional relationship with peers

Professional relationship with other health care professionals

Professional relationship with administration Ability to accept constructive criticism Leadership qualities

Awareness

Page 2 of 4 Voting & Surveys - Athletic Training Student Clinical Experience Evaluation (UNI S&C ...

Dependability Work ethic

5) Comments for Personal Attributes (please comment on any ranking of 1 or 2):

Answer length:00 (Max: 2048)

6) Professional Attributes

Based on the following scale, identify the student's performance for each professional attribute listed. *Excellent (5): the attribute is effectively demonstrated 80%-100% of the time.

*Above average (4): the attribute is effectively demonstrated 60%-80% of the time. *Average (3): the attribute is effectively demonstrated 40%-60% of the time. *Below average (2): the attribute is effectively demonstrated 20%-40% of the time. *Poor (1): the attribute is demonstrated less than 20% of the time.*

Poor Below Average Average Above Average Excellent N/A Demonstrates confidence

Able to effectively communicate Demonstrates critical thinking Demonstrates problem solving

Uses equipment and resources appropriately Seeks advice for improvement

7) Comments for Professional Attributes (please comment on any ranking of 1 or 2):

Answer length:00 (Max: 2048)