UNIVERSITY OF SOUTH FLORIDA COLLEGE OF NURSING DAILY STUDENT ANECDOTAL NOTE student's Name: § . WNSSOF pate: 1}24 1 (4 course MVS TE semester_3 a. Number of hours worked on unit: | C CLINICAL PRECEPTOR: ‘ooveange Avge Bel ge A Motivation to Leara y a Patient Assessment a q g stil @ q a Sat Documentation 4 Zw g a Professionalism a oa o Comments Vere Ja54 Yo woe wots tagger p Bear ‘Poaclor Preceptor Name: _ Elaun (Please Print) Preceptor Signature: eS STUDENT EVALUATION OF PRECEPTOR: ‘Check all that apply Above Avgrage Average Below Average Knowledgeable we “Ee ons Encouraged learning wy a Qo Supportive wy g 8 Act as role model Professionalism oy a a © Eun WS G& Wonderte) plecepror! | feel Nee Ll wos Cnte PY ACLOMMPLENN G LOL OHNE Vewme moie Lahforteuste CUINICALFACULTY: Vy (4 Uvpcal (OAt Setng Agree/Disagree with evaluations. Clinical Pae Comments (including preceptor feedbael): nature op Pele oS Revised May 2012 Std