Appendix D
Affective Evaluations


INSTRUCTIONS FOR AFFECTIVE STUDENT EVALUATIONS

There are two primary purposes of an affective evaluation system: 1) to verify competence in the affective domain, and 2) to serve as a method to change behavior. Although affective evaluation can be used to ultimately dismiss a student for unacceptable patterns of behavior, that is not the primary purpose of these forms. It is also recognized that there is some behavior that is so serious (abuse of a patient, gross insubordination, illegal activity, reporting for duty under the influence of drugs or alcohol, etc) that it would result in immediate dismissal from the educational program.

The two forms included in the EMT-Intermediate: National Standard Curricula were developed by the Joint Review Committee on Educational Programs for the EMT-Paramedic. They represent extensive experience in the evaluation of student=s affective domain. The nature of this type of evaluation makes it impossible to achieve complete objectivity, but these forms attempt to decrease the subjectivity and document affective evaluations.

In attempting to change behavior it is necessary to identify, evaluate, and document the behavior that you want. The eleven affective characteristics that form the basis of this evaluation system refer to content in the Roles and Responsibilities of the Paramedic unit of the curriculum. Typically, this information is presented early in the course and serves to inform the students what type of behavior that is expected of them. It is important that the instructor is clear about these expectations.

Cognitive and psychomotor objectives are relatively easy to operationalize in behavioral terms. Unfortunately, the nature of the affective domain makes it practically impossible to enumerate all of the possible behaviors that represent professional behavior in each of the eleven areas. For this reason, the instructor should give examples of acceptable and unacceptable behavior in each of the eleven attributes, but emphasize that these are examples and do not represent an all inclusive list.

The affective evaluation instruments included in this curriculum take two forms: A Professional Behavior Evaluation and a Professional Behavior Counseling Record. The Professional Behavior Evaluation should be completed regularly (i.e. every other week, once a month, etc.) by faculty and preceptors about each student. It is recommended that this form be completed by as many people as practically possible and that it becomes part of the students record. The more independent evaluations of the student, the more reliable are the results.

The only two options for rating the student on this form are Acompetent@ and Anot yet competent@. For each attribute, a short list of behavioral markers is listed that indicates what is generally considered a demonstration of competence for entry level paramedics. This is not an all inclusive list, but serves to help the evaluator in making judgments. Clearly there are behaviors which warrant a Anot yet competent@ evaluation that are not listed. Any ratings of Anot yet competent@ require explanation in the space provided.

Establishing a cut score to use in conjunction with the Professional Behavior Evaluation instrument is important. A cut score can be established by judgment of the local programs community of interest. The question the community should ask is, what percent score do we expect of graduates of our education program to achieve in the affective domain in order to demonstrate entry level competency for a (first month, second semester, graduate, etc.) level student?

When the cut score judgment is made on acceptability or deviation of competent behavior for each characteristic a percent score can be achieved. For example, a student may received 10 competent checks out of 11 (10 of 11 = 91%), or 5 of 7 (because 4 areas were not evaluated) for a score of 71%. This student may then continue to obtain scores of 91%, 91% 82%, etc and have a term grade of 86% in the affective domain. Each student in the program would receive an average score. Results of multiple evaluations throughout the program would indicate if the score set by the community of interest was too high or too low. When a number of evaluations had evolved adjustments in acceptable score would yield a standard for the community. This standard coupled with community of interest judgments based upon graduate student and employer survey feedbacks would identify additional validity evidence for the cut score each year. A valid cut score based upon years of investigation could then be used as a determining factor on future participation in the education program.

For all affective evaluations, the faculty member should focus on patterns of behavior, not isolated instances that fall outside the students normal performance. For example, a student who is consistently on time and prepared for class may have demonstrated competence in time management and should not be penalized for an isolated emergency that makes him late for one class. On the other hand, if the student is constantly late for class, they should be counseled and if the behavior continues, rated as Anot yet competent@ in time management. Continued behavior may result in disciplinary action.

The second form, the Professional Behavior Counseling form is used to clearly communicate to the student that their affective performance is unacceptable. This form should be used during counseling sessions in response to specific incidents (i.e. cheating, lying, falsification of documentation, disrespect/insubordination, etc.) or patterns of unacceptable behavior. As noted before, there is some behavior that is so egregious as to result in immediate disciplinary action or dismissal. In the case of such serious incidents, thorough documentation is needed to justify the disciplinary action. For less serious incidents, the Professional Behavior Counseling form can serve as an important tracking mechanism to verify competence or patterns of uncorrected behavior.

On the Professional Behavior Counseling form, the evaluator checks all of the areas that the infraction affects in the left hand column (most incidents affect more than one area) and documents the nature of the incident(s) in the right hand column. Space is provided to document any follow-up. This should include specific expectations, clearly defined positive behavior, actions that will be taken if the behavior continues, and dates of future counseling sessions.

Using a combination of these forms helps to enable the program to demonstrate that graduating students have demonstrated competence in the affective domain. This is achieved by having many independent evaluations, by different faculty members at different times, stating that the student was competent. These forms can also be used to help correct unacceptable behavior. Finally, these forms enable programs to build a strong case for dismissing students following a repeated pattern of unacceptable behavior. Having numerous, uncollaborated evaluations by faculty members documenting unacceptable behavior, and continuation of that behavior after remediation, is usually adequate grounds for dismissal.


PROFESSIONAL BEHAVIOR EVALUATION

Student's Name:_____________________________________________________________________________

Date of evaluation:___________________________________________________________________________

1. INTEGRITY

Competent [ ]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Consistent honesty; being able to be trusted with the property of others; can be trusted with confidential information; complete and accurate documentation of patient care and learning activities.

2. EMPATHY

Competent [ ]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Showing compassion for others; responding appropriately to the emotional response of patients and family members; demonstrating respect for others; demonstrating a calm, compassionate, and helpful demeanor toward those in need; being supportive and reassuring to others.

3. SELF - MOTIVATION

Competent [ ]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Taking initiative to complete assignments; taking initiative to improve and/or correct behavior; taking on and following through on tasks without constant supervision; showing enthusiasm for learning and improvement; consistently striving for excellence in all aspects of patient care and professional activities; accepting constructive feedback in a positive manner; taking advantage of learning opportunities

4. APPEARANCE AND PERSONAL HYGIENE

Competent [ ]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Clothing and uniform is appropriate, neat, clean and well maintained; good personal hygiene and grooming.

5. SELF - CONFIDENCE

Competent [ ]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Demonstrating the ability to trust personal judgment; demonstrating an awareness of strengths and limitations; exercises good personal judgment.

6. COMMUNICATIONS

Competent [ ]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Speaking clearly; writing legibly; listening actively; adjusting communication strategies to various situations

7. TIME MANAGEMENT

Competent [ ]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Consistent punctuality; completing tasks and assignments on time.

8. TEAMWORK AND DIPLOMACY

Competent [ ]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Placing the success of the team above self interest; not undermining the team; helping and supporting other team members; showing respect for all team members; remaining flexible and open to change; communicating with others to resolve problems.

9. RESPECT

Competent [ ]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Being polite to others; not using derogatory or demeaning terms; behaving in a manner that brings credit to the profession.

10. PATIENT ADVOCACY

Competent [ ]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Not allowing personal bias to or feelings to interfere with patient care; placing the needs of patients above self interest; protecting and respecting patient confidentiality and dignity.

11. CAREFUL DELIVERY OF SERVICE

Competent [ ]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Mastering and refreshing skills; performing complete equipment checks; demonstrating careful and safe ambulance operations; following policies, procedures, and protocols; following orders.

Use the space below to explain any Anot yet competent@ ratings. When possible, use specific behaviors, and corrective actions.

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________


_________________________________- Faculty Signature


PROFESSIONAL BEHAVIOR EVALUATION

Student=s Name: Steve R.

Date of evaluation: November 1999

1. INTEGRITY

Competent [T]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Consistent honesty; being able to be trusted with the property of others; can be trusted with confidential information; complete and accurate documentation of patient care and learning activities.

2. EMPATHY

Competent [ ]

Not yet competent [T]

Examples of professional behavior include, but are not limited to: Showing compassion for others; responding appropriately to the emotional response of patients and family members; demonstrating respect for others; demonstrating a calm, compassionate, and helpful demeanor toward those in need; being supportive and reassuring to others.

3. SELF - MOTIVATION

Competent [T]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Taking initiative to complete assignments; taking initiative to improve and/or correct behavior; taking on and following through on tasks without constant supervision; showing enthusiasm for learning and improvement; consistently striving for excellence in all aspects of patient care and professional activities; accepting constructive feedback in a positive manner; taking advantage of learning opportunities

4. APPEARANCE AND PERSONAL HYGIENE

Competent [T]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Clothing and uniform is appropriate, neat, clean and well maintained; good personal hygiene and grooming.

5. SELF - CONFIDENCE

Competent [ ]

Not yet competent [T]

Examples of professional behavior include, but are not limited to: Demonstrating the ability to trust personal judgment; demonstrating an awareness of strengths and limitations; exercises good personal judgment.

6. COMMUNICATIONS

Competent [ ]

Not yet competent [T]

Examples of professional behavior include, but are not limited to: Speaking clearly; writing legibly; listening actively; adjusting communication strategies to various situations

7. TIME MANAGEMENT

Competent [T]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Consistent punctuality; completing tasks and assignments on time.

8. TEAMWORK AND DIPLOMACY

Competent [ ]

Not yet competent [T]

Examples of professional behavior include, but are not limited to: Placing the success of the team above self interest; not undermining the team; helping and supporting other team members; showing respect for all team members; remaining flexible and open to change; communicating with others to resolve problems.

9. RESPECT

Competent [ ]

Not yet competent [T]

Examples of professional behavior include, but are not limited to: Being polite to others; not using derogatory or demeaning terms; behaving in a manner that brings credit to the profession.

10. PATIENT ADVOCACY

Competent [T]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Not allowing personal bias to or feelings to interfere with patient care; placing the needs of patients above self interest; protecting and respecting patient confidentiality and dignity.

11. CAREFUL DELIVERY OF SERVICE

Competent [T]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Mastering and refreshing skills; performing complete equipment checks; demonstrating careful and safe ambulance operations; following policies, procedures, and protocols; following orders.

Use the space below to explain any Anot yet competent@ ratings. When possible, use specific behaviors, and corrective actions.

#2, 5, 6, 8, & 9 Steve has demonstrated inappropriate classroom behavior by monopolizing class time, answering questions intended for other students, and making sarcastic remarks about other students answers. Steve demonstrates a superiority complex over fellow classmates belittling and has repeatedly belittled their experience, while boasting and exaggerating about his field experience.

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

T. Jones - Faculty Signature


PROFESSIONAL BEHAVIOR EVALUATION

Student=s Name: Steve R.

Date of evaluation: December 1999

 

1. INTEGRITY

Competent [T]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Consistent honesty; being able to be trusted with the property of others; can be trusted with confidential information; complete and accurate documentation of patient care and learning activities.

2. EMPATHY

Competent [ ]

Not yet competent [T]

Examples of professional behavior include, but are not limited to: Showing compassion for others; responding appropriately to the emotional response of patients and family members; demonstrating respect for others; demonstrating a calm, compassionate, and helpful demeanor toward those in need; being supportive and reassuring to others.

3. SELF - MOTIVATION

Competent [T]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Taking initiative to complete assignments; taking initiative to improve and/or correct behavior; taking on and following through on tasks without constant supervision; showing enthusiasm for learning and improvement; consistently striving for excellence in all aspects of patient care and professional activities; accepting constructive feedback in a positive manner; taking advantage of learning opportunities

4. APPEARANCE AND PERSONAL HYGIENE

Competent [T]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Clothing and uniform is appropriate, neat, clean and well maintained; good personal hygiene and grooming.

5. SELF - CONFIDENCE

Competent [ ]

Not yet competent [T]

Examples of professional behavior include, but are not limited to: Demonstrating the ability to trust personal judgment; demonstrating an awareness of strengths and limitations; exercises good personal judgment.

6. COMMUNICATIONS

Competent [ ]

Not yet competent [T]

Examples of professional behavior include, but are not limited to: Speaking clearly; writing legibly; listening actively; adjusting communication strategies to various situations

7. TIME MANAGEMENT

Competent [T]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Consistent punctuality; completing tasks and assignments on time.

8. TEAMWORK AND DIPLOMACY

Competent [ ]

Not yet competent [T]

Examples of professional behavior include, but are not limited to: Placing the success of the team above self interest; not undermining the team; helping and supporting other team members; showing respect for all team members; remaining flexible and open to change; communicating with others to resolve problems.

9. RESPECT

Competent [ ]

Not yet competent [T]

Examples of professional behavior include, but are not limited to: Being polite to others; not using derogatory or demeaning terms; behaving in a manner that brings credit to the profession.

10. PATIENT ADVOCACY

Competent [ ]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Not allowing personal bias to or feelings to interfere with patient care; placing the needs of patients above self interest; protecting and respecting patient confidentiality and dignity.

11. CAREFUL DELIVERY OF SERVICE

Competent [ ]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Mastering and refreshing skills; performing complete equipment checks; demonstrating careful and safe ambulance operations; following policies, procedures, and protocols; following orders.

Use the space below to explain any Anot yet competent@ ratings. When possible, use specific behaviors, and corrective actions.

#2 Steve is constantly disrupting class with irrelevant questions. He is disrespectful to guest instructors, classmates and the program.

#5 Steve seems to have an impression that he is better than the others students because he has more field experience. He is overconfident and overbearing.

#6 Steve has not changed his communication skills despite verbal counseling.

#8 Steve=s disruptions are destructive to the team environment by placing his needs above those of the group.

#9 Disruptions are disrespectful.

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

A. Cox -Faculty Signature


PROFESSIONAL BEHAVIOR EVALUATION

Student=s Name: Janet L.

Date of evaluation: September 1998

 

1. INTEGRITY

Competent [T]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Consistent honesty; being able to be trusted with the property of others; can be trusted with confidential information; complete and accurate documentation of patient care and learning activities.

2. EMPATHY

Competent [T]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Showing compassion for others; responding appropriately to the emotional response of patients and family members; demonstrating respect for others; demonstrating a calm, compassionate, and helpful demeanor toward those in need; being supportive and reassuring to others.

3. SELF - MOTIVATION

Competent [T]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Taking initiative to complete assignments; taking initiative to improve and/or correct behavior; taking on and following through on tasks without constant supervision; showing enthusiasm for learning and improvement; consistently striving for excellence in all aspects of patient care and professional activities; accepting constructive feedback in a positive manner; taking advantage of learning opportunities

4. APPEARANCE AND PERSONAL HYGIENE

Competent [T]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Clothing and uniform is appropriate, neat, clean and well maintained; good personal hygiene and grooming.

5. SELF - CONFIDENCE

Competent [T]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Demonstrating the ability to trust personal judgment; demonstrating an awareness of strengths and limitations; exercises good personal judgment.

6. COMMUNICATIONS

Competent [ ]

Not yet competent [T]

Examples of professional behavior include, but are not limited to: Speaking clearly; writing legibly; listening actively; adjusting communication strategies to various situations

7. TIME MANAGEMENT

Competent [ ]

Not yet competent [T]

Examples of professional behavior include, but are not limited to: Consistent punctuality; completing tasks and assignments on time.

8. TEAMWORK AND DIPLOMACY

Competent [T]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Placing the success of the team above self interest; not undermining the team; helping and supporting other team members; showing respect for all team members; remaining flexible and open to change; communicating with others to resolve problems.

9. RESPECT

Competent [T]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Being polite to others; not using derogatory or demeaning terms; behaving in a manner that brings credit to the profession.

10. PATIENT ADVOCACY

Competent [T]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Not allowing personal bias to or feelings to interfere with patient care; placing the needs of patients above self interest; protecting and respecting patient confidentiality and dignity.

11. CAREFUL DELIVERY OF SERVICE

Competent [T]

Not yet competent [ ]

Examples of professional behavior include, but are not limited to: Mastering and refreshing skills; performing complete equipment checks; demonstrating careful and safe ambulance operations; following policies, procedures, and protocols; following orders.

Use the space below to explain any Anot yet competent@ ratings. When possible, use specific behaviors, and corrective actions.

Janet=s run reports, written case reports, and home work are illegible and disorganized. She has numerous spelling and grammatical errors. Janet repeatedly hands in assignments after due dates. She does not complete clinical time in a organized, organized manner. She did not report for five scheduled clinical shifts this semester and reported to medic 6 twice when she was not scheduled. Janet has not completed the required clinical for this semester. ______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

 

John Brown - Faculty Signature


PROFESSIONAL BEHAVIOR COUNSELING RECORD

Student=s Name:_____________________________________________________________________________

Date of counseling:___________________________________________________________________________

Date of incident:_____________________________________________________________________________

U

Reason for Counseling

Explanation (use back of form if more space is needed):

 

Integrity

 

 

Empathy

 

 

Self - Motivation

 

 

Appearance/Personal Hygiene

 

 

Self - Confidence

 

 

Communications

 

 

Time Management

 

 

Teamwork and Diplomacy

 

 

Respect

 

 

Patient Advocacy

 

 

Careful delivery of service

 

 

 

Follow-up (include specific expectations, clearly defined positive behavior, actions that will be taken if behavior continues, dates of future counseling sessions, etc.):

 

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

 

_________________________________-Faculty signature

I have read this notice and I understand it.

_________________________________-Student signature

_________________________________-Administrative or Medical Director Review

 


PROFESSIONAL BEHAVIOR COUNSELING RECORD

Student=s Name: Steve R.

Date of counseling: December 14, 1998 Date of incident: November and December 1999

U

Reason for Counseling

Explanation (use back of form if more space is needed):

 

Integrity

This counseling session was in response to the two Professional Behavior

Y

Empathy

Evaluations file by Instructors Cox and Jones. They both indicated that

 

Self - Motivation

Steve has been disruptive in classes (see attached)

 

Appearance/Personal Hygiene

 

Y

Self - Confidence

 

Y

Communications

 

 

Time Management

 

Y

Teamwork and Diplomacy

 

Y

Respect

 

 

Patient Advocacy

 

 

Careful delivery of service

 

 

 

Follow-up (include specific expectations, clearly defined positive behavior, actions that will be taken if behavior continues, dates of future counseling sessions, etc.):

 

! Student was advised that his behavior is inappropriate and unacceptable. Continuation of this behavior will result in dismissal from class.

! Written warning from program director. ! Instructors Cox and Jones to complete Professional Behavior Evaluations bi-weekly throughout next semester ________________________________________________________________________________________________________________________________________________________________________________________

____________________________________________________________________________________________

 

M. Travis -Faculty signature
I have read this notice and I understand it.

Steve R. -Student signature

Dr. O=Hara -Administrative or Medical Director Review


PROFESSIONAL BEHAVIOR COUNSELING RECORD

Student=s Name: Joe L.

Date of counseling: February 23, 1999 Date of incident: February 21, 1999

U

Reason for Counseling

Explanation (use back of form if more space is needed):

 

Integrity

Joe reported to a field rotation 16 minutes late, he was not wearing (nor

 

Empathy

did he have in his possession) a uniform belt and with Aat least 2 days

 

Self - Motivation

beard growth@ according to field supervisor Johnson. When Joe was

U

Appearance/Personal Hygiene

approached regarding this situation he became argumentative and told

 

Self - Confidence

Mr. Johnson to A... mind your own business.@ Joe was asked to leave.

 

Communications

Others that witnessed this exchange were Paramedics Davis and

U

Time Management

Lawrence.

 

Teamwork and Diplomacy

 

U

Respect

 

 

Patient Advocacy

 

 

Careful delivery of service

 

 

Follow-up (include specific expectations, clearly defined positive behavior, actions that will be taken if behavior continues, dates of future counseling sessions, etc.):

! Reviewed clinical Policies and Procedures manual section referring to personal appearance and hygiene, time management, and respect. I also reviewed the conduct at clinical rotations with Joe.

! Asked Joe to writ a letter of apology to field supervisor Johnson, and Paramedics Davis and Lawrence, which he agreed to do. ! I informed Joe that any further display of disrespectful behavior will result in dismissal from the program. A continued pattern of poor time management and/or poor appearance/personal hygiene could also result in dismissal. ____________________________________________________________________________________________

 

Bill Smith -Faculty signature
I have read this notice and I understand it.

Joe L. -Student signature

Dr. Jones -Administrative or Medical Director Review