Regional Scholarship Program Director/Clinic Instructor Evaluation Form

Applicant's Name(Required)
Address(Required)
Evaluator Information(Required)

Rating Scale

Please indicate the extent to which the applicant displays the following characteristics.
Demonstrates outstanding performance in the clinical or didactic setting(Required)
Excellent rapport with patients, peers and staff(Required)
Punctual, prepared and attentive(Required)
Demonstrates excellent critical-thinking skills(Required)
Shows motivation/initiative(Required)
Teamwork and dependability(Required)
Ethical Behavior(Required)
Emotional Control(Required)

Recommendation

Choose from the following(Required)
In the space above, please supply any additional information that will help in the assessment of the applicant. What separates the applicant from peers as a radiologic professional.