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Date: Quarter:


Assigned areas or units:

Instructions: Read each statement and check the appropriate box. Do not enter your name. The
instructor submits the completed forms at the end of each rotation.

Strongly Agree Disagree Strongly

Agree Disagree
1. There was adequate and appropriate space for
student conferences.
2. There was a receptive and positive learning
environment for the instructional program.
3. There were treatment plans available that were
current and appropriate.
4. There were adequate resources (supplies,
equipment, manuals) available for student
5. The stability of staffing provided a consistent
learning environment.
6. The variety of patient/client population provided
sufficient learning experiences for students
7. The patient/client census was sufficient to meet
course objectives.
8. Sufficient variety of health problems were
represented within the patient population.
9. The policy and procedure manuals were
available and current.

Other Comments: