Community and Institutional IPPE Affidavit and Preceptor Evaluation - onu 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Student Name and Rank in the designated fields. Ensure accuracy as this information is crucial for identification.
3. Fill in the Site Name and Address where the experience took place. This provides context for the evaluation.
4. Select the Type of Experience by circling either 'Community' or 'Institutional'. This helps categorize the evaluation appropriately.
5. Complete the Preceptor's details, including Name, Phone Number, Email Address, and License Number. This verifies who conducted the evaluation.
6. Evaluate the student’s performance in various areas such as professionalism, knowledge base, communication skills, and participation. Select one of the options: Exceeds expectations, Meets expectations, or Does not meet expectations for each category.
7. Provide comments for each evaluation area to give detailed feedback on the student's performance.
8. List any areas where the student excels and indicate areas needing improvement in their respective sections.
9. Finally, assess whether the student's completion of hours and objectives was Acceptable or Unacceptable. Enter the number of hours completed at the site.
10. Sign and date at the bottom of the form to finalize your evaluation.

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