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Rural Medical Education
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Emergency Medicine 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
*Student Performance Evaluation Form Yes No
*Student Site Evaluation Form Yes No
*Video Lecture Evaluation #1 Yes No
*Video Lecture Evaluation #2 Yes No
*Procedure/Skills Card Yes No

Notes: