Student Evaluation of the Clinical Instructor Question Title * 1. Please complete this survey and submit. Student Name: CI Name: Facility Name: Affiliation Dates (Mo/Day/Year) Question Title * 2. The Clinical Instructor was prepared for my first day and oriented me to the department. Does not apply Strongly disagree Disagree Agree Strongly agree Does not apply Strongly disagree Disagree Agree Strongly agree Question Title * 3. The Clinical Instructor was familiar with the policies of the facility in which he/she worked. Does not apply Strongly disagree Disagree Agree Strongly agree Does not apply Strongly disagree Disagree Agree Strongly agree Question Title * 4. The Clinical Instructor introduced me to other employees of the department. Does not apply Strongly disagree Disagree Agree Strongly agree Does not apply Strongly disagree Disagree Agree Strongly agree Question Title * 5. The Clinical Instructor was confident and instructed me in the proper departmental proceedings. Does not apply Strongly disagree Disagree Agree Strongly agree Does not apply Strongly disagree Disagree Agree Strongly agree Question Title * 6. The Clinical Instructor was supportive of my knowledge of modalities, and assisted me when needed. Does not apply Strongly disagree Disagree Agree Strongly agree Does not apply Strongly disagree Disagree Agree Strongly agree Question Title * 7. The Clinical Instructor was familiar with my didactic work prior to this clinical experience. Does not apply Strongly disagree Disagree Agree Strongly agree Does not apply Strongly disagree Disagree Agree Strongly agree Question Title * 8. The Clinical Instructor spent adequate time with me, but allowed me some freedom with patient care. Does not apply Strongly disagree Disagree Agree Strongly agree Does not apply Strongly disagree Disagree Agree Strongly agree Question Title * 9. There was some good interaction with other PT personnel as well as other personnel in the facility. Does not apply Strongly disagree Disagree Agree Strongly agree Does not apply Strongly disagree Disagree Agree Strongly agree Question Title * 10. The Clinical Instructor allowed adequate time to complete my clinical duties. Does not apply Strongly disagree Disagree Agree Strongly agree Does not apply Strongly disagree Disagree Agree Strongly agree Question Title * 11. I would recommend this Clinical Instructor to other students. Does not apply Strongly disagree Disagree Agree Strongly agree Does not apply Strongly disagree Disagree Agree Strongly agree Question Title * 12. Please add any additional comments you wish to make about this Clinical Instructor or the overall clinical experience. Done