Clinical Facilitator : Week: Course Coordinator: 1 Course: Dates of Placement: Student Student Academic Student CF/ Student CF/ Student Clinical Progress Attended leave days Liaison If progress unsatisfactory, please Student Name Placement leave days Meetings Phone calls challenge in satisfactory Venue (total to contact provide brief details (this week) (number) (number) place Y/N Y/N Orientation date) required Y/N Clinical Facilitator : Week: Course Coordinator: 2 Course: Dates of Placement:
Clinical Facilitator : Week: Course Coordinator: Course: 1 Dates of Placement: Student Name Placement Student Attended Venue Orientation Student leave days (this week) Student leave days (total to date) CF/ Student Meetings (number) CF/ Student Phone calls (number) Clinical challenge in place Y/N Progress satisfactory Y/N Academic Liaison contact required Y/N If progress unsatisfactory, please provide brief details Clinical Facilitator : Week: Course Coordinator: Course: 2 Dates of Placement:
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