Totals ===> APPENDIX E1 Clinical Affiliate Institutional Data Form – (return to Accreditation Self Study Report AFFILIATE #: [ ] CLINICAL AFFILIATION MATRIX Name: Address: Chief Administrative Officer: Telephone #: Distance from location of program? [ ] miles [ ] [ ] Is a signed, current agreement with this affiliate? Yes No [ ] [ ] Who supervises the students? affiliate personnel program personnel [ ] [ ] Are written policies as to what students may do in each area? Yes No [ ] [ ] Are the preceptors formally trained? Yes No For how many hours? Rehabilitation Engineering Number of and Assistive Technology Observations Area Seating and mobility AAC (Augmentative/alternative communication)
Totals ===> APPENDIX E1 – Clinical Affiliate Institutional Data Form (return to Accreditation Self Study Report AFFILIATE #: [ ] CLINICAL AFFILIATION MATRIX Name: Address: Chief Administrative Officer: Telephone #: Distance from location of program? [ ] miles Is a signed, current agreement with this affiliate? [ ] Yes [ ] No Who supervises the students? [ ] affiliate personnel [ ] program personnel Are written policies as to what students may do in each area? [ ] Yes [ ] No Are the preceptors formally trained? [ ] Yes [ ] No For how many hours? Rehabilitation Engineering and Assistive Technology Area Number of Observations Seating and mobility AAC (Augmentative/alternative communication)