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Idaho State University

Clinical Affiliate Student Evaluation Form

ISU Medical Laboratory Science Program
Clinical Affiliate Evaluation of Student
Affective Domain - Online Evaluation - Confidential

Dear ISU MLS Clinical Affiliate,
Thank you very much for your support of the Idaho State University Medical Laboratory Science Program. The expertise shared by you and other laboratory professionals in your facility to the MLS student during clinical rotation has been invaluable.

NAACLS Accreditation requires that the MLS Program obtain feedback regarding your experiences with our students. This feedback is critical and will be utilized to improve the program.

Please take a few minutes to evaluate students that have spent time in your facility. We are also interested in speaking with you further about any questions or concerns that you may have.

Please evaluate the student with respect to these professional level competencies. This information is required in addition to the ISU Internship check off list which verifies the level of proficiency of the MLS student attained on a minimum set of psychomotor tasks.

Please use the following scale to complete the evaluation:

1 = Nearly always
2 = Frequently; may require minimal prompting
3 = Neutral; neither way with moderate prompting
4 = Infrequently
5 = Never
6 = Not Observed

The ISU MLS Program Director will review your responses and make changes as needed in consultation with all outcome evaluation information.

Thank you very much for your time and input.

Rachel Hulse
ISU MLS Program Director

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