CHS/GMHETC Clerkships Rotations

Two-Week Site Evaluation Form

This form is designed to help CHS/GMHETC evaluate the quality of the sites where students are placed for their clinical rotations. This form must be completed after the first 2 weeks of the rotation in order to make necessary adjustments early in the rotation and make the rotation a worthwhile learning experience for students.

**Please be assured that information you provide on this form cannot be used against you in any shape or form and will not have any impact whatsoever on your performance evaluation/grades for this clinical rotation.**

Student's Name

Parent School

Type of Rotation:

Core

Elective

Rotation Length:

Start Date:

End Date:

Site Name & Address:

Preceptor(s) Name(s):

Hours of Operation:

How many days per week have you been assigned?

Are staff members at the site receptive to you?

Yes No

How many patients does your preceptor see with you per day?

Does your preceptor takes time to precept you?

Yes No

If No, please explain:

Are you comfortable with your preceptor?

Yes No

If No, please explain:

Student Signature

Greater Miami
Health Education
and Training Center
(GMHETC)

Greater Miami Health Education and Training Center (GMHETC)

Center for Haitian Studies, Health & Human Services, Inc. (CHS)

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