The Gail & Richard Lumpkin School of Nursing (Traditional Program) Faculty/Student Evaluation of Clinical Sites

Student's Name: Student's Name: First Last
Course: *
Semester: *
Clinical Site: *

Please rate the following statements according to this scale:

5 = Strongly Agree, 4 = Agree, 3 = Somewhat Agree, 2 = Disagree, 1 = Strongly Disagree *
	1 Strongly Disagree	2 Disagree	3 Somewhat Agree	4 Agree	5 Strongly Agree	Not Applicable
1. The agency/site provided an adequate volume and variety of patients necessary to meet the course objectives.	1. The agency/site provided an adequate volume and variety of patients necessary to meet the course objectives.1 Strongly Disagree	1. The agency/site provided an adequate volume and variety of patients necessary to meet the course objectives.2 Disagree	1. The agency/site provided an adequate volume and variety of patients necessary to meet the course objectives.3 Somewhat Agree	1. The agency/site provided an adequate volume and variety of patients necessary to meet the course objectives.4 Agree	1. The agency/site provided an adequate volume and variety of patients necessary to meet the course objectives.5 Strongly Agree	1. The agency/site provided an adequate volume and variety of patients necessary to meet the course objectives.Not Applicable
2. The agency/site provided learning experiences that contributed to student acquistion of the required knowledge, skills, and personal behaviors/attitudes necessary to meet the course objectives.	2. The agency/site provided learning experiences that contributed to student acquistion of the required knowledge, skills, and personal behaviors/attitudes necessary to meet the course objectives.1 Strongly Disagree	2. The agency/site provided learning experiences that contributed to student acquistion of the required knowledge, skills, and personal behaviors/attitudes necessary to meet the course objectives.2 Disagree	2. The agency/site provided learning experiences that contributed to student acquistion of the required knowledge, skills, and personal behaviors/attitudes necessary to meet the course objectives.3 Somewhat Agree	2. The agency/site provided learning experiences that contributed to student acquistion of the required knowledge, skills, and personal behaviors/attitudes necessary to meet the course objectives.4 Agree	2. The agency/site provided learning experiences that contributed to student acquistion of the required knowledge, skills, and personal behaviors/attitudes necessary to meet the course objectives.5 Strongly Agree	2. The agency/site provided learning experiences that contributed to student acquistion of the required knowledge, skills, and personal behaviors/attitudes necessary to meet the course objectives.Not Applicable
3. The physical spaces at the agency/site were adequate to promote achievement of course objectives.	3. The physical spaces at the agency/site were adequate to promote achievement of course objectives.1 Strongly Disagree	3. The physical spaces at the agency/site were adequate to promote achievement of course objectives.2 Disagree	3. The physical spaces at the agency/site were adequate to promote achievement of course objectives.3 Somewhat Agree	3. The physical spaces at the agency/site were adequate to promote achievement of course objectives.4 Agree	3. The physical spaces at the agency/site were adequate to promote achievement of course objectives.5 Strongly Agree	3. The physical spaces at the agency/site were adequate to promote achievement of course objectives.Not Applicable
4. The staff at the agency/site were knowledgeable and offered guidance when needed. Staff encouraged a collaborative relationsihp with faculty and students that promoted an environment conducive for student learning.	4. The staff at the agency/site were knowledgeable and offered guidance when needed. Staff encouraged a collaborative relationsihp with faculty and students that promoted an environment conducive for student learning.1 Strongly Disagree	4. The staff at the agency/site were knowledgeable and offered guidance when needed. Staff encouraged a collaborative relationsihp with faculty and students that promoted an environment conducive for student learning.2 Disagree	4. The staff at the agency/site were knowledgeable and offered guidance when needed. Staff encouraged a collaborative relationsihp with faculty and students that promoted an environment conducive for student learning.3 Somewhat Agree	4. The staff at the agency/site were knowledgeable and offered guidance when needed. Staff encouraged a collaborative relationsihp with faculty and students that promoted an environment conducive for student learning.4 Agree	4. The staff at the agency/site were knowledgeable and offered guidance when needed. Staff encouraged a collaborative relationsihp with faculty and students that promoted an environment conducive for student learning.5 Strongly Agree	4. The staff at the agency/site were knowledgeable and offered guidance when needed. Staff encouraged a collaborative relationsihp with faculty and students that promoted an environment conducive for student learning.Not Applicable
5. The agency/site provided an adequate orientation to the facility.	5. The agency/site provided an adequate orientation to the facility.1 Strongly Disagree	5. The agency/site provided an adequate orientation to the facility.2 Disagree	5. The agency/site provided an adequate orientation to the facility.3 Somewhat Agree	5. The agency/site provided an adequate orientation to the facility.4 Agree	5. The agency/site provided an adequate orientation to the facility.5 Strongly Agree	5. The agency/site provided an adequate orientation to the facility.Not Applicable
6. Patient records were accessible and available to students.	6. Patient records were accessible and available to students.1 Strongly Disagree	6. Patient records were accessible and available to students.2 Disagree	6. Patient records were accessible and available to students.3 Somewhat Agree	6. Patient records were accessible and available to students.4 Agree	6. Patient records were accessible and available to students.5 Strongly Agree	6. Patient records were accessible and available to students.Not Applicable

What did you like best about your experience at this agency/site? *
What recommendations do you have, if any, for future experiences at this agency/site? *