ST Externship Feedback

Please complete the following externship evaluation. Indicate whether your response to the statement is strongly agree, agree, disagree, or strongly disagree. This is to your general, personal perspective of your externship experience. Thank you for your honest feedback.


A red asterisk (*) indicates required questions.

  1. The mentor(s) was an effective communicator.*
      1 2 3 4 5  
    Strongly agree   Strongly disagree


  1. The mentor(s) showed respect and sensitivity towards me.*
      1 2 3 4 5  
    Strongly agree   Strongly disagree


  1. The mentor(s) answered my questions effectively.*
      1 2 3 4 5  
    Strongly agree   Strongly disagree


  1. The mentor(s) encouraged me to ask questions.*
      1 2 3 4 5  
    Strongly agree   Strongly disagree


  1. The mentor(s) motivated me to learn.*
      1 2 3 4 5  
    Strongly agree   Strongly disagree


  1. The mentor(s) was patient with me.*
      1 2 3 4 5  
    Strongly agree   Strongly disagree


  1. The mentor(s) assistance was helpful to me.*
      1 2 3 4 5  
    Strongly agree   Strongly disagree


  1. The mentor(s) enjoyed teaching me.*
      1 2 3 4 5  
    Strongly agree   Strongly disagree


  1. I understood how the clinical site functioned.*
      1 2 3 4 5  
    Strongly agree   Strongly disagree


  1. The weekly visit from my instructor was sufficient for my learning.*
      1 2 3 4 5  
    Strongly agree   Strongly disagree


  1. The instructor's assistance during externship met my needs.*
      1 2 3 4 5  
    Strongly agree   Strongly disagree


  1. I understood the externship evaluation process.*
      1 2 3 4 5  
    Strongly agree   Strongly disagree


  1. I can apply knowledge gained in this externship experience to my future career.*
      1 2 3 4 5  
    Strongly agree   Strongly disagree


  1. Externship prepared me for employment.*
      1 2 3 4 5  
    Strongly agree   Strongly disagree


  1. Because of the externship experience, I have grown in the area(s) of...……..…..*


  1. I would or would not recommend my externship site to future students. Why or why not?*


  1. Approximate number of cases I scrubbed on during externship is*


  1. Additional comments...





Nancy Dancs
Pewaukee, WI