UNSOM- Department of Speech Pathology and Audiology

External Program Evaluation Form


University of Nevada, Reno Department of Speech Pathology and Audiology External Program Evaluation Form (to be completed by former students following their first year of employment)
Date:	Name (required):
Degree:	Area:
		(Speech-Language Path/ Audiology)
This questionnaire is part of the University of Nevada, Reno, Department of Speech Pathology and Audiology competency evaluation component. Please indicate the descriptor that best fits your ability to:
Use diagnostic materials and techniques.
Prepare and execute screening procedures.
Select and schedule clients for treatment.
Use a variety of treatment methods, procedures, and /or techniques.
Apply behavior modifications techniques (i.e. behavioral control, reinforcement, tracking, charting, etc.)
Modify the speech and language behavior of clients.
Report outcomes and keep records.
Develop meaningful rapport with clients.
Work effectively with colleagues and other professionals.
Respond to constructive supervision.
Consult and educate clients and families.
Please indicate the level of :
Your overall professional commitment and involvement.
Overall training at UNR.
In relation to other speech and hearing clinicians who trained at settings other than UNR, my training can be rated as. . .
Comments:

Please list your place of employment, address, name of supervisor, supervisor's phone and e-mail address, if applicable.
Place of Employment:
Address
Name of Supervisor
Supervisor's Phone
Supervisor's e-mail

Please contact klewis@med.unr.edu