Medical Dosimetry Program

Phone 616-331-5752, Fax 616-331-5632

College of Health Professions
Center for Health Sciences
301 Michigan Street, Suite 412
Grand Rapids, Michigan 49503
CLINICAL ADVISING PROGRAM DOSIMETRIST EVALUATION
Student Name
Clinical Education Center

Date
Course #

Semester & Year

INSTRUCTIONS: Please rate the student in the following categories by checking inside the appropriate box. We appreciate honest
and candid responses as they are essential to the students' professional growth. DO NOT COMPLETE THIS FORM UNLESS YOU
HAVE WORKED WITH THE STUDENT!
Grading Rubric (see detailed explanation in the Student Handbook):
Poor-Zero (0) points indicating does not meet acceptable standard
Fair-One (1) points indicating meets standard but needs significant improvement
Good-Two (2) points indicating meets acceptable standard
Excellent-Three (3) points indicating exceeds acceptable standard
Excellent
(3 points)

Good
(2)

Fair
(1)

Poor
(0)

1. PROFESSIONAL CONDUCT
mannerisms, cleanliness, neatness
2. ATTITUDE
enthusiasm for profession, interest in assigned activities
3. COMMUNICATION SKILLS
interpersonal skills c/ staff
4. PATIENT CARE SKILLS
awareness of emotions, modesty, provide information to patient
5. COOPERATION
willingness to assume duties
6. DEPENDABILITY
punctuality & reliability
7. SELF-CONFIDENCE
confidence in personal ability
8. APPLICATION OF KNOWLEDGE
use of academic information
9. ORGANIZATION OF DUTIES
logical & efficient performance
10. ADAPTABILITY
ability to adapt to changing situations, prioritize duties and cases

Please use the back of this form to provide additional commentary you believe could be useful in improving
the educational experience of this student.
Evaluator (Sign & Date)

Student (Sign & Date)

I have reviewed this evaluation and have had opportunity for
discussion.

GVSU Medical Dosimetry Program Student Handbook

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