Clinical Safari: Preceptor Evaluation Form

If you were a preceptor for a Clinical Safari, please fill out this evaluation form. The individual information you provide will be held strictly confidential. Any data will be reported in aggregate form only with any personal identifiers removed.

1. Your Name (0ptional):

2. Your Position:

3. Date you hosted a Safari: (___/___/200_)

4. Approximate # of hours you spent with the student: (numeric value)

5. Safari Type: If other, please describe:

6. In what way was this a worthwhile experience for you?

- What surprised you?

- What was the best thing that happened?

- What would you change?

7. How would you rate your student:

(5 = outstanding..........4..........3 = good..........2..........1 = poor)

8. How would you rate the overall Safari Experience:

(5 = outstanding..........4..........3 = good..........2..........1 = poor)

9. Based on this experience, would you host on another Safari?

(5 = definitely yes..........4..........3 = maybe.........2..........1 = definitely not)

Thank you very much!