Medical Office Specialist Evaluation (GCC)

Please mark the following statements with the most appropriate values. These values show the extent to which you believe your extern has shown their level of dedication.

  • (Please enter the first and last name of your extern, ex. John Smith)
  • (Please enter the number of total days attended, ex. 30)
  • (Please enter the number days absent, ex. 2)
  • (Please enter the number days tardy, ex. 1)
  • (PLEASE NOTE: A total of 160 hours is required.)

  • Practical Experience In:

  • Work Habits and Attitude:

  • (Please indicate strong or weak points of this student's performance)
  • (Please choose a letter grade)
  • (Please enter your name, ex. James Brown)
  • (Please enter your job title, ex. Supervisor)
  • (Please enter the externship site, ex. St. Joseph's Hospital)
  • / /
    (Please enter today's date)