WEEKLY MEETING FORM

Student’s Name:___________________________________

Clinical Instructor:__________________________________

                                                                                                             Week#:_______________________________

STUDENT	CI COMMENTS
Learning Experiences:
Areas of Strength:

PLEASE SEE OTHER SIDE

STUDENT	CI COMMENTS
Areas Needing Improvement:
Goals/Objectives for Next Week:

Student Signature__________________________________Date _____________       

CI Signature ______________________________________Date_____________

*Remember to send to CCCE each week!

Revised:  March 1999