Angelo State University Clinical Instructor Evaluation Form
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1Appendix L.
Angelo State University
Doctor of Physical Therapy Program
Clinical Instructor Evaluation Form
Clinical Instructor:
Facility:
Yes __ No __
Current license to practice in the state of the facility.
Yes __ No __
Minimum of one-year full-time experience in clinical practice.
Yes __ No __
* Credentialed Clinical Instructor (APTA, Texas Consortium or other)
*Optional, but desired
Circle the word that best expresses your assessment of this clinical instructor. Please comment when appropriate.
1.
Communicates effectively with student physical therapist, Center Coordinator of Clinical Education, and
Academic Coordinator of Clinical Education.
Poor
Fair
Good
Very Good
Excellent
Comments
Evaluates each student’s progress appropriately.
2.
Poor
Fair
Good
Very Good
Excellent
Comments
3.
Supervises each student effectively.
Poor
Fair
Good
Very Good
Excellent
Comments
Provides appropriate learning experiences based on student’s knowledge and skill level.
4.
Poor
Fair
Good
Very Good
Excellent
Comments
5.
Practices in a safe, ethical and legal manner.
Poor
Fair
Good
Very Good
Excellent
Comments
6.
Maintains clinical competence through continuing education.
Poor
Fair
Good
Very Good
Excellent
Comments
7.
Models professional behavior.
Poor
Fair
Good
Very Good
Excellent
Comments
8.
Recognizes appropriate role of student in clinical setting.
Poor
Fair
Good
Very Good
Excellent
Comments
I recommend that ASU student physical therapists continue to be assigned to this Clinical Instructor
_____ without reservation.
_____ after further communication/training. ______ do not recommend.
Comments: (use reverse side for additional space)
Signature:
Date:
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