Final Assessment CI

Please fill this out and return to me during the last week of the clinical rotation.
Name: 


A red asterisk (*) indicates required questions.

  1. Student name:*


  1. Clinical experience number (1, 2, or 3)*


  1. Name of clinical education site and location (include city and state):*


  1. PT/PTA degree earned:*


  1. Years of experience as a clinician:*


  1. How many students have you taken?*


  1. List specialty certifications or advanced proficiencies. If none, put N/A.*


  1. Check each of the settings that this location offers:*
    Acute care/Inpatient
    Outpatient
    SNF
    Private practice
    Rehabillitation/subacute
    School/preschool


  1. What curricular suggestions do you have that would better prepare our students for this clinical?*


  1. What specific qualities or skills do you believe a PTA student should have to function successfully at this clinical education site?*


  1. Are you a credentialed clinical instructor through the APTA?
    Yes
    No


  1. Please rank the CPI 3.0 on the scale below.
      1 2 3 4 5  
    Excellent   Poor


  1. Please add any feedback to improve the CPI 3.0 below.





Physical Therapist Assistant Program
Physical Therapist Assistant Instructor
Lake Area Technical Institute