Fall 2009 School Nurse Internship University Supervisor's Evaluation

FORM TITLE:
Do not change this title. (For administrative use only.)

*Date
Select the date by clicking on the "calendar" button shown to the right.

School Nurse students (Fall 2009)

*School Nurse

*Grade Level

*District

School

*1. Describe activities reflecting NASN standards of Professional School Nursing Practice and entry level competencies for school nurses that the student has participated in to date.

*2. Describe the relationship between the student, the cooperating nurse, children and other school personnel at present.

*3. Describe the student's dispositions(cultural diversity, ability and potential, motivation and resiliency) related to the Reflective Urban Practioner Model that he or she has utilized in the role of the school nurse within the Health Office.

*4. Describe the student's attitude toward the internship experience and his or her reflection on its challenges.

*5. Describe the student's progress regarding the Activities Checklist and the student's perception of his or her professional growth during the internship.

*6.Describe problems that may exist at present.

*7. Other Comments

*Supervisor

*Supervisor Authorization Code
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