Student's Name *
Supervisor's Name *
Preceptor’s name
Name of organization *
Overall Evaluation For each statement below, please select the response that best reflects your judgement:
My workspace and computer access were ready at the beginning of my practicum. *
-Select- Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not applicable
The practicum objectives were clearly outlined in the beginning. *
-Select- Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not applicable
Deliverables were clearly identified at the beginning. *
-Select- Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not applicable
The practicum has provided me with useful knowledge. *
-Select- Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not applicable
The practicum has allowed me to develop my competencies. *
-Select- Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not applicable
The practicum has allowed me to apply knowledge and skills that I learned during my coursework. *
-Select- Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not applicable
The level of responsibility I was given was appropriate. *
-Select- Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not applicable
Overall, my practicum was a success. *
-Select- Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not applicable
Practicum Environment For each statement below, please select the response that best reflects your judgement:
My practicum environment was welcoming. *
-Select- Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not applicable
My practicum environment was stimulating. *
-Select- Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not applicable
My practicum environment allowed me to be part of a team. *
-Select- Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not applicable
My Supervisor For each statement below, please select the response that best reflects your judgement:
My supervisor helped me clarify my practicum mandate, its goals and objectives. *
-Select- Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not applicable
My supervisor was available for meetings and to answer my questions. *
-Select- Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not applicable
My supervisor helped clarify relevant procedures and methods that I needed as part of my practicum. *
-Select- Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not applicable
My supervisor helped me to adapt to my practicum environment and to become part of the team. *
-Select- Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not applicable
My supervisor helped me collaborate with other team members with whom I pursued my practicum project. *
-Select- Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not applicable
My supervisor offered me quality feedback and discussed my strength and opportunities of improvement with me. *
-Select- Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not applicable
My supervisor debriefed my practicum and provided feedback prior to / at the end of my practicum. *
-Select- Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not applicable
Overall, my experience with my practicum supervisor was positive. *
-Select- Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree Not applicable
My Preceptor For each statement below, please select the response that best reflects your judgement:
My preceptor helped me clarify my practicum mandate, its goals and objectives.
-Select- Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not applicable
My preceptor was available for meetings and to answer my questions.
-Select- Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not applicable
My preceptor helped clarify relevant work processes and methods that I needed as part of my practicum.
-Select- Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not applicable
My preceptor offered me quality feedback and discussed my strength and opportunities of improvement with me.
-Select- Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not applicable
My preceptor helped me collaborate with other team members with whom I pursued my practicum project.
-Select- Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not applicable
My preceptor helped me collaborate with other team members with whom I pursued my practicum project. My preceptor helped me to adapt to my practicum environment and to become part of the team.
-Select- Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not applicable
Overall, my experience with my preceptor was positive.
-Select- Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not applicable
General Appreciation of the Practicum For each statement below, please select the response that best reflects your judgement:
In general, I appreciated my practicum experience. *
-Select- Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not applicable
The practicum is an important part of my training. *
-Select- Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not applicable
All in all, I recommend this practicum placement to other students. *
-Select- Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not applicable