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Completed Weekly

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Weekly Student Performg

Student Name
Clinical Skills
(Assessments,
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Procedures, Patient
and Family
Education, etc.)

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Skills/Care
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ProblemSolving Skills

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Relationships/
Communication
Skills
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Telephone skills,
etc.)

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Electronic/Paper
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Other Specific
Situations
or
Areas Needing
Experience

To be completed by both the Student and the Preceptor before the end of the last shift of the
work week. Give a copy to the Student. Retain a copy to be given to the school faculty member
at next scheduled

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Student Signature:

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Preceptor Signature:

Date: l9

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