Rural Medical Education | Community Hospital Clerkship

Oklahoma State University
Center for Health Sciences

Rural Medical Education

Community Hospital Clerkship

Checklist

Course requirements listed below are due the end of the rotation and must be submit within 7 days of completing this rotation. If all items are not received by the 7th, points will be deducted from the final grade. You may print this out for your own record.

*Denotes required fields
*First Name	*Email

*Phone	*Alternate Phone/Pager
(Enter your 10 digit number without other characters; i.e. no dashes, no parenthesis).

	Check yes if completed
*CH 1 Student Performance Evaluation Form	Yes	No
*CH 2 Student Performance Evaluation Form	Yes	No
*CH 1 Site Evaluation Form	Yes	No
*CH 2 Site Evaluation Form	Yes	No
*Video Lecture Evaluation #1	Yes	No
*Video Lecture Evaluation #2	Yes	No
*Video Lecture Evaluation #3	Yes	No
*Video Lecture Evaluation #4	Yes	No

Notes: