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ÃÛÌÒÓ°Ïñ Athletic Training Education
ÃÛÌÒÓ°Ïñ Athletic Training Education
Student Evaluation Form
Student's Name
Student's Name
First
Last
Clinical Preceptor
Clinical Preceptor
First
Last
Clinical Site/Rotation
Date
Date
/
MM
/
DD
YYYY
Clinical Semester
I (Spring Freshmen)
II (Fall Sophomore)
III (Spring Sophomore)
IV (Fall Junior)
V (Spring Junior)
VI (Fall Senior)
VII (Spring Senior)
Other - Internship
Section Break
Professional Behavior
Punctual
*
5 - Excellent, well above clinical level
4 - Good, better than most at clinical level
3 - Average, consistent with clinical level
2 - Fair, below what is expected at clinical level
1 - Poor, minimal or no ability
0 - Have not observed
Wears Proper Attire
*
5 - Excellent, well above clinical level
4 - Good, better than most at clinical level
3 - Average, consistent with clinical level
2 - Fair, below what is expected at clinical level
1 - Poor, minimal or no ability
0 - Have not observed
Participates with daily clinical routines
*
5 - Excellent, well above clinical level
4 - Good, better than most at clinical level
3 - Average, consistent with clinical level
2 - Fair, below what is expected at clinical level
1 - Poor, minimal or no ability
0 - Have not observed
Is organized with daily clinical responsibilities
*
5 - Excellent, well above clinical level
4 - Good, better than most at clinical level
3 - Average, consistent with clinical level
2 - Fair, below what is expected at clinical level
1 - Poor, minimal or no ability
0 - Have not observed
Demonstrates enthusiasm/motivation in job performance
*
5 - Excellent, well above clinical level
4 - Good, better than most at clinical level
3 - Average, consistent with clinical level
2 - Fair, below what is expected at clinical level
1 - Poor, minimal or no ability
0 - Have not observed
Demonstrates professional responsibilities and ethics
*
5 - Excellent, well above clinical level
4 - Good, better than most at clinical level
3 - Average, consistent with clinical level
2 - Fair, below what is expected at clinical level
1 - Poor, minimal or no ability
0 - Have not observed
Is receptive to instruction/direction
*
5 - Excellent, well above clinical level
4 - Good, better than most at clinical level
3 - Average, consistent with clinical level
2 - Fair, below what is expected at clinical level
1 - Poor, minimal or no ability
0 - Have not observed
Completes assigned tasks on time
*
5 - Excellent, well above clinical level
4 -Good, better than most at clinical level
3 - Average, consistent with clinical level
2 - Fair, below what is expected at clinical level
1 - Poor, minimal or no ability
0 - Have not observed
Develops positive rapport with athletes
*
5 - Excellent, well above clinical level
4 - Good, better than most at clinical level
3 - Average, consistent with clinical level
2 - Fair, below what is expected at clinical level
1 - Poor, minimal or no ability
0 - Have not observed
Develops positive rapport with peers
*
5 - Excellent, well above clinical level
4 - Good, better than most at clinical level
3 - Average, consistent with clinical level
2 - Fair, below what is expected at clinical level
1 - Poor, minimal or no ability
0 - Have not observed
Participates in learning opportunities
*
5 - Excellent, well above clinical level
4 - Good, better than most at clinical level
3 - Average, consistent with clinical level
2 - Fair, below what is expected at clinical level
1 - Poor, minimal or no ability
0 - Have not observed
Takes initiative with clinical skills
*
5 - Excellent, well above clinical level
4 - Good, better than most at clinical level
3 - Average, consistent with clinical level
2 - Fair, below what is expected at clinical level
1 - Poor, minimal or no ability
0 - Have not observed
Demonstrates confidence with performance and interactions
*
5 - Excellent, well above clinical level
4 - Good, better than most at clinical level
3 - Average, consistent with clinical level
2 - Fair, below what is expected at clinical level
1 - Poor, minimal or no ability
0 - Have not observed
Demonstrates sound knowledge in athletic training according to level
*
5 - Excellent, well above clinical level
4 - Good, better than most at clinical level
3 - Average, consistent with clinical level
2 - Fair, below what is expected at clinical level
1 - Poor, minimal or no ability
0 - Have not observed
Overall, how would you rate the ATS according to their professional behavior
*
5 - Excellent, well above clinical level
4 - Good, better than most at clinical level
3 - Average, consistent with clinical level
2 - Fair, below what is expected at clinical level
1 - Poor, minimal or no ability
0 - Have not observed
Section Break
Clinical Skills
Taping Tecniques
*
5 - Excellent, well above clinical levle
4 - Good, better than most at clinical level
3 - Average, consistent with clinical level
2 - Fair, below what is expected at clinical level
1 - Poor, minimal or no ability
0 - Have not observed
Equipment Fitting Techniques
*
5 - Excellent, well above clinical level
4 - Good, better than most at clinical level
3 - Average, consistent with clinical level
2 - Fair, below what is expected at clinical level
1 - Poor, minimal or no ability
0 - Have not observed
Treatment/First Aid Techniques
*
5 - Excellent, well above clinical level
4 - Good, better than most at clinical level
3 - Average, consistent with clinical level
2 - Fair, below what is expected at clinical level
1 - Poor, minimal or no ability
0 - Have not observed
Modality Use
*
5 - Excellent, well above what is expected at clinical level
4 - Good, better than most at clinical level
3 - Average, consistent with clinical level
2 - Fair, below what is expected at clinical level
1 - Poor, minimal or no ability
0 - Have not observed
Evaluation/Assessment Skills
*
5 - Excellent, well above clinical level
4 - Good, better than most at clinical level
3 - Average, consistent with clinical level
2 - Fair, below what is expected at clinical level
1 - Poor, minimal or no ability
0 - Have not observed
Rehabilitation Techniques
*
5 - Excellent, well above clinical level
4 - Good, better than most at clinical level
3 - Average, consistent with clinical levle
2 - Fair, below what is expected at clinical level
1 - Poor, minimal or no ability
0 - Have not observed
Knowledge and Use of Medications
*
5 - Excellent, well above clinical level
4 - Good, better than most at clinical level
3 - Average, consistent with clinical level
2 - Fair, below what is expected at clinical level
1 - Poor, minimal or no ability
0 - Have not observed
Knowledge and Use of Athletic Training Supplies
*
5 - Excellent, well above clinical level
4 - Good, better than most at clinical level
3 - Average, consistent with clinical levle
2 - Fair, below what is expected at clinical level
1 - Poor, minimal or no ability
0 - Have not observed
Record Keeping Procedures
*
5 - Excellent, well above clinical level
4 - Good, better than most at clinical level
3 - Average, consistent with clinical level
2 - Fair, below what is expected at clinical level
1 - Poor, minimal or no ability
0 - Have not observed
Facility/Team Management Skills
*
5 - Excellent, well above clinical level
4 - Good, better than most at clinical level
3 - Average, consistent with clinical level
2 - Fair, below what is expected at clinical level
1 - Poor, minimal or no ability
0 - Have not observed
Overall, how would you rate the ATS according to their clinical skills
*
5 - Excellent, well above clinical level
4 - Good, better than most at clinical level
3 - Average, consistent with clinical level
2 - Fair, below what is expected at clinical level
1 - Poor, minimal or no ability
0 - Have not observed
Additional Comments
Strengths
Needs improving
Have they shown improvement?
*
Athletic Training Student E-Signature
Athletic Training Student E-Signature
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