Dietetic Internship Program Forms & Evaluations

Evaluation Forms

The following are the evaluations to be used with The Sage Colleges Dietetic Internship Programs:

Preceptor Forms - Clinical Rotations (Acute Care, Long Term Care, Outpatient)

Intern Clinical Performance Evaluation -

1) Preceptor uses this form to evaluate the intern's performance in clinical rotations (acute care, long term care and outpatient, i.e., diabetes and renal)

2) This form is to be completed once during rotations that are shorter than 4 weeks and twice (at mid-rotation and end-of-rotation) during rotations that are 4 weeks or longer

Evaluation of Oral Case Study/Journal Presentation - Preceptor and other attendees are to complete this form evaluating intern's presentation on the final case study and on the journal presentations

Evaluation for Diet Education - Preceptor (or other RD/health professional) observes intern during diet education and counseling and rates intern performance using this form. A minimum of three forms should be completed during acute care rotation

 

Preceptor Forms - Management, Community and Wellness Rotations

Intern Management/Community Performance Evaluation -

1) Preceptor uses this form to evaluate the intern's performance in food service and management, wellness, nutrition education, school and community rotations

2) This form is to completed once during rotations that are shorter than 4 weeks and twice (at mid-rotation and end-of-rotation) during rotations that are 4 weeks or longer

Evaluation of Oral Presentations (PI Project, In-services, Etc.) - Preceptor and other attendees are to complete this form evaluating intern's oral presentation(s)

Evaluation of Education and Counseling for Behavior Change -Preceptor is to evaluate intern on their performance while conducting education and counseling for behavior change, Twice during community practicum.

Preceptor Forms - Distance Track

Preceptor Application Form

 

Intern Forms -

Weekly Practicum Hours Verification Form - Intern completes this form on a weekly basis to report total number of hours completed each week

Clinical Rotation Checklist - Intern uses this form as a checklist to ensure that specific DI clinical requirements have been met. Form is to be completed at the end of each clinical and community rotation

Intern Evaluation of Preceptor and Facility - Intern completes this form once at the end of each rotation

Intern Evaluation of Rotation- Intern completes this form once at the end of each rotation