Student Evaluator Survey

This form should be completed WEEKLY to inform us of individuals you have worked with. Complete by 8 pm on Sunday so that evaluations can be delivered on Monday AM. If submitted after that, your evaluations won’t go out until the following week.

Rotation Block*
Week of Rotation*
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List any supervisors you worked with who are not listed on the Team Schedule (these supervisors have already been assigned evaluations). NOTE: You are still required to submit this form even if you don't have any additional evaluators to list. To find the Team Schedule, see Evaluation System Tools on the clerkship website: https://med.stanford.edu/pediatricsclerkship/300A.html

List the supervisors you worked with this week.

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