Please update this information about your hours to date: Current Current Last name, FT Total number Total number Total number number Total number 25 observation Total number Year session: Fall, name FTL of direct of direct of direct of direct of direct of direct Spring, or PT client/patient client/patient client/patient client/patient client/patient client/patient Summer contact hours contact hours contact hours contact hours contact hours contact hours in in P1 in P2 in P3 (FT and in Externship (the previous 5 (if FT Leveler columns added applicable & students only) together) signed) Please provide the following information about your supervisor/s: (Do not include NAU supervisors) Site name City Supervisor’s name Supervisor’s If your clinical rotation was your Externship, please complete the information below: Name of site City Were you offered Rating a position at the - HR (Highly recommend) externship site: - R (Recommend) Yes or No - DNR (Do not recommend) Possibly provide brief additional comments.
Please update this information about your hours to date: Current Year Current session: Fall, Spring, or Summer Last name, name FT FTL PT Total number of direct client/patient contact hours in (if applicable & signed) Total number of direct client/patient contact hours in P1 Total number of direct client/patient contact hours in P2 number of direct client/patient contact hours in P3 (FT and FT Leveler students only) Total number of direct client/patient contact hours in Externship 25 observation Total number of direct client/patient contact hours (the previous 5 columns added together) Please provide the following information about your supervisor/s: (Do not include NAU supervisors) Site name City Supervisor’s name Supervisor’s If your clinical rotation was your Externship, please complete the information below: Name of site City Were you offered a position at the externship site: Yes or No Rating - HR (Highly recommend) - R (Recommend) - DNR (Do not recommend) Possibly provide brief additional comments.
CLINICAL%20ROTATION%20FEEDBACK.docx