UNM Medical Student Evaluation

This form is for UNM Non-Catalog, Research, Teaching, or Away Electives

EVALUATIONS ARE DUE WITHIN TWO WEEKS OF THE ROTATION END DATE.

Evaluations may be entered directly into this form.

Additional information or host school evaluations may be uploaded where noted.

Student Information

STUDENT First Name

Please enter the first name of the STUDENT being evaluated.

STUDENT Last Name

Please enter the last name of the STUDENT being evaluated.

UNM Student ID

Helpful if known. Included on automated reminders. (No dashes, please).

Course Information

Was this rotation done at the University of New Mexico?

YES

Course Type

Clinical Elective

Non-Clinical Elective

Sub-Internship

ICU

Evaluation

In addition to the narrative, ALL EVALUATIONS MUST INCLUDE A GRADE OR GRADE EQUIVALENT OF (Outstanding, Good, Satisfactory, Fail) OR Credit/No Credit.

Do you have a COMPLETED evaluation form from your institution ready for upload?

PLEASE CHECK ONE OF THE FOLLOWING:

NO - the remainder of this evaluation form will appear for direct entry.

YES - please drag the completed PDF or Word doc to the Document Upload section below.

Document Upload

Any additional supporting documentation (i.e institutional evaluations with narratives) may be uploaded here.

Drop your files here

Evaluator Information

Evaluating Faculty or Department Coordinator Email

Please list a valid email address for any questions related to this evaluation.

Evaluating Faculty Name and Title

I certify that I am authorized to submit an evaluation for this student.

Evaluating Faculty Institution

Evaluation Date

mm/dd/yyyy

Please click "Submit" at the bottom of this form.

Thank You

We greatly appreciate the time spent evaluating our students. If you have any questions or comments, please do not hesitate to reach out to our office.

University of New Mexico School of Medicine

Office of Medical Student Affairs

hsc-omsa@salud.unm.edu

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