UNIVERSITY OF SOUTH FLORIDA COLLEGE OF NURSING DAILY STUDENT ANECDOTAL NOTE suadenr same: S-\\(SCL Dat (ue course MC IL Semester_4 Assigned unit: (CTS Number of hours worked on units _| 2 CLINICAL PRECEPTOR: ‘Above Aver Average Below Average NIA Movivationo Learn el i oo Patent Assessment a o Q Q stills ng o o a Satety Eg a fe g Documentation Professionalism ao a a Comments: Wy bof phd - (reest to wok with toe \ Preceptor Name} WM, \\ 1 A hi (Please Print) Preceptot Siam: y/o te STUDENT EVALUATION OF PRECEPTOR: ‘Check all hat apply AboveWernge Average Below Average Knowledgeable Q Q Encouraged learning, a a Supportive ag gq ‘Acts as role model Q a Professionalism a o v CLINICAL FACULT Agree/Disagree with evaluations. ‘Comments (including preceptor feedbac Faculty Signature Student Signature Revised May 2012