Agency Preceptor's Final Evaluation of Student and Fieldwork Program

Thank you for completing this evaluation. We value your contribution and ask that you please be candid in your evaluation as your feedback is very valuable to our program and our students

Students in the NYU MPH program pursue one of three concentrations:

* Community and International Health
* Global Health Leadership
* Public Health Nutrition

We ask that ALL preceptors complete SECTION I (student evaluation) and SECTION II (NYU MPH Internship Program evaluation).

In addition, we ask preceptors who worked with students in the Community and International Health Concentration and Public Health Nutrition Concentration to complete SECTION III.

Please select the concentration of the student with whom you worked.

SECTION I: FINAL EVALUATION OF STUDENT BY AGENCY PRECEPTOR

1. Contact information:

Student Name Required Question

Agency Name Required Question

Agency Address

Agency Preceptor Required Question

Preceptor Title

Semester & Year

Fieldwork start date: Required Question

Fieldwork end date: Required Question

Email Address Required Question

Phone Number Required Question

2. Describe your contact with the student (e.g. how often did you meet with the student to discuss project progress)?

3. Did the fieldwork goals change in any way during its course? If yes, please describe the change(s) and how the organization and student managed the change(s).

4. Were the goals / objectives as presented in the Internship Approval Form / Learning Contract achieved?

5. Did the student distinguish him / herself in any way during the experience? If yes, please describe.

6. Please describe the student’s impact, if any, on the work of the organization.

7. Please describe observed professional STRENGTHS demonstrated by the student during his/her fieldwork experience.

8. Please describe observed professional WEAKNESSES demonstrated by the student during his/her fieldwork experience.

9. Please rate the student on the following professional characteristics. Ranking Scale: 1=Poor, 2=Fair, 3=Average, 4=Good, 5=Excellent.

	1 (poor)	2 (fair)	3 (average)	4 (good)	5 (excellent)
Overall commitment to public health
Initative in acquiring new knowledge and skills
Application of academic knowledge and skills
Ability to self-directing
Communication skills (overall)
Verbal communication
Written communication
Maturity
Teamwork
Dependability
Flexibility

10. OVERALL PERFORMANCE: Based on your experience with the student, please select the letter grade that you would recommend for this student's performance (please use the scale presented below): Required Question

11. Would you accept another student from the NYU MPH Program? If yes, when may we contact you about the next fieldwork opportunity?

12. Additional comments:

SECTION II: EVALUATION OF THE NYU MPH PROGRAM

13. Please rate the NYU MPH Internship/Practicum Program.

	Excellent	Good	Fair	Poor
Preparedness of student
Supervision of the student by NYU faculty
Clarity of fieldwork expectations
Support provided by the NYU MPH Practice Administration

14. Please provide additional comments you may have about our internship/practicum program.

Upon completion of this question:

If you served as a preceptor to a student in the Global Health Leadership concentration, please skip to Q16 at the end of this survey.
If you served as a preceptor to a student in the Community/International Health or Public Health Nutrition concentration, please continue on to SECTION III below.

SECTION III : ADDITIONAL EVALUATION FOR STUDENTS IN THE COMMUNITY AND INTERNATIONAL HEALTH CONCENTRATION OR PUBLIC HEALTH NUTRITION CONCENTRATION

We ask preceptors who worked with students in the Community and International Health Concentration and Public Health Nutrition Concentration ONLY to complete this section.

In reviewing the Public Health Core Competencies outlined in the student's Internship Learning Contract, please assess the extent to which the student demonstrated mastery of these competencies during the fieldwork experience.

Student competency Ranking Scale: 4=High Level of Competency Exhibited, 3=Good Level of Competency Exhited, 2=Acceptable Level of Competency Exhibited, 1=Unacceptable Level of Competency Exhibited, N/A= Not Applicable

15. ANALYTIC ASSESSMENT SKILLS:

	High Level of Competence Exhibited	Good Level of Competence Exhibited	Acceptable Level of Competence Exhibited	Unacceptable Level of Competence Exhibited	Not Applicable
Defines a problem
Identifies relevant and appropriate data and information sources
Applies ethical principles to collection, use, and dissemination of information
Determines appropriate uses of quantitative and qualitative data

POLICY DEVELOPMENT/PROGRAM PLANNING SKILLS:

	High Level of Competence Exhibited	Good Level of Competence Exhibited	Acceptable Level of Competence Exhibited	Unacceptable Level of Competence Exhibited	Not Applicable
Collects, summarizes and interprets information relevant to an issue
Translates policy into organizational plans, structures and programs
Develops mechanisms to monitor and evaluate programs for their effectiveness and quality

COMMUNICATION SKILLS

	High Level of Competence Exhibited	Good Level of Competence Exhibited	Acceptable Level of Competence Exhibited	Unacceptable Level of Competence Exhibited	Not Applicable
Communicates effectively both in writing and orally, or in other ways
Solicits input from individuals and organizations
Effectively presents demographic, statistical, programmatic, and scientific information for professional and lay audience
Listens to others in an unbiased manner, respects points of view of others

CULTURAL COMPETENCY SKILLS:

	High Level of Competence Exhibited	Good Level of Competence Exhibited	Acceptable Level of Competence Exhibited	Unacceptable Level of Competence Exhibited	Not Applicable
Utilizes appropriate methods for interacting sensitively, effectively and professionally with diverse populations
Identifies the role of cultural, social and behavioral factors in determining the delivery of public health services
Develops and adapts approaches to problems that take into account cultural differences

COMMUNITY DIMENSIONS OF PRACTICE SKILLS:

	High Level of Competence Exhibited	Good Level of Competence Exhibited	Acceptable Level of Competence Exhibited	Unacceptable Level of Competence Exhibited	Not Applicable
Utilizes leadership, team building, negotiation, and conflict resolution skills to build community partnerships
Identifies how public and private organizations operate within a community
Describes the role of government in the delivery of community health services

BASIC PUBLIC HEALTH SCIENCES SKILLS:

	High Level of Competence Exhibited	Good Level of Competence Exhibited	Acceptable Level of Competence Exhibited	Unacceptable Level of Competence Exhibited	Not Applicable
Defines, assesses, and understands the health status of populations, factors contributing to health promotion and disease prevention and factors influencing the use of health services
Applies basic public health sciences (behavioral and social, biostatistics, epidemiology, environmental health, and prevention of chronic and infectious diseases)
Identifies and retrieves current relevant scientific evidence and identifies the limitations of research

FINANCIAL PLANNING AND MANAGEMENT SKILLS:

	High Level of Competence Exhibited	Good Level of Competence Exhibited	Acceptable Level of Competence Exhibited	Unacceptable Level of Competence Exhibited	Not Applicable
Monitors program performance
Applies basic human relations skills to the management of organizations, motivation of personnel and resolution of conflicts

LEADERSHIP AND SYSTEMS THINKING SKILLS:

	High Level of Competence Exhibited	Good Level of Competence Exhibited	Acceptable Level of Competence Exhibited	Unacceptable Level of Competence Exhibited	Not Applicable
Creates a culture of ethical standards within organizations and communities
Promotes team and organizational learning
Contributes to development, implementation, and monitoring of organizational performance standards

16. By clicking on the 'submit' button you are affirming that the information you have provided is true and correct.

Please type your name in the box below. Required Question