| Performance
- How do you rate your competency and knowledge
in handling your current position?
* |
12345 |
| Planning and Organizing -
Set personal objectives, schedules time to
achieve objectives, correlate all objectives,
obtains and utilizes resources, prepared for
client and group sessions, completes assignments
timely. * |
12345 |
| Gathering and Evaluating Data
- Works within policies and procedures of
agency; obtains, analyzes and provides accurate
nutrition information, develops and implements
individual nutritional care plans, explains
interrelationships of data, makes appropriate
changes; analytical and problem-solving ability,
use of research and evaluation methods.
* |
12345 |
| Applying Scientific Principles of
Nutrition - Recognizes all factors affecting
nutritional needs, accurately interprets data
based on current nutrition theory and knowledge,
individual and realistic care plans, utilizes
appropriate references, implements nutritional
care plans and evaluates effectiveness.
* |
12345 |
| Oral and Written Communications
- Addresses clients at level of understanding,
establishes open communications, listens
effectively, expresses questions and information
appropriately, uses appropriate mannerisms,
documents correctly, expresses written thought
clearly and neatly, uses appropriate literary
style, writing consistently free of errors.
* |
12345 |
| Human Relations -
Establishes rapport with clients, faculty and
peers, demonstrates appropriate conduct; content
of questions and comments appropriate, establish
open communications, listens effectively,
functions as a team member.
* |
12345 |
| Teaching Skills
- Advance preparation, follows teaching-learning
guide (objectives, etc.), utilizes appropriate
resources (visuals, etc.), appropriate time and
setting, establishes rapport, teaches at
appropriate level of understanding, exhibits
creativity and resourcefulness, seeks and uses
learning opportunities, stimulates learning.
* |
12345 |
| Acceptance of Responsibility
- On time, prepared for assignments,
cooperative, reliable, utilizes time
efficiently, follows directions, manages
responsibilities within a day, flexible,
indicates unfinished work and follows through,
recognition of evaluation as learning process.
* |
12345 |
| Professional Performance
- Maintains ethical standards, respect for
others’ confidentiality, seeks additional
learning opportunities, adheres to agency
policies, personal appearance, professionally
dressed, well groomed.
* |
12345 |
| Management Skills -
Manages resources efficiently, establishes short
and long term goals and objectives, pursues
innovative methods in daily practice, seeks new
ways to improve productivity and revenue, has
good managerial skills.
* |
12345 |
Please answer the following by selecting either yes or no and completing the
blanks as appropriate. |
|
1. Do you currently conduct and/or
participate in any research activities? |
Yes
No |
| If yes, please describe:
|
|
2.
How many continuing education hours have you
attained since graduation?
* |
|
|
Please list if any were attained:
|
|
3. Are you currently involved or do
you participate in Journal Club via your place
of business, association, internet, or
individually? |
Yes
No |
| If yes, how:
|
|
Do you utilize the information attained from
Journal club or continuing education in your
daily practice? |
Yes
No |
|
If yes, how:
|
|
|
4. Are you currently involved in
National, State, or Local Professional
Associations? * |
Yes
No |
| If yes, which ones?
|
|
5. Are you registered? |
Yes
No |
| If no, please indicate why not:
|
|
6. Are you licensed? |
Yes
No |
| If no, please indicate why not:
|
|
7. Have you obtained any
additional credentials or certifications since graduation?
* |
Yes
No |
| If yes, please list.
|
|
8. Do you currently participate in
community service/nutrition activities?
* |
Yes
No |
| If yes, please list.
|
|
9.
Did you apply to any post-graduate degree
program since you graduation from the
internship? * |
Yes
No |
| If yes, please list.
|
|
10. Where you accepted by the
program? * |
Yes
No |
|
11. Did preceptors and staff of the
dietetic internship encourage you to complete
the internship? * |
Yes
No |
| If yes, please
explain your response.
|
| 12. Were the staff
and preceptors supportive of you during the
internship? * |
Yes
No |
| If yes, please
explain your response.
|
| 13. Please
give us any comments regarding our internship:
|