Clinical Experience Goals and Objectives

INSTRUCTIONS: Please complete this form prior to beginning the clinical experience with the Athletic Training Student. Prior to submitting this form, please print a copy for your records

Athletic Training Student Information:

Student's Name:   Phone:

Site Information:

Clinical Site: Season:  Year:

Beginning Date:   Ending Date:  

Clinical Instructor Information:

Clinical Supervisor:     Phone:

Email Address:

Schedule Information:

Please select the days and hours this student will be scheduled for clinical experience. Remember that each student must be scheduled for 15-20 hours a week

Days per week
Start Time
End time

Field Experience Goals and Objectives:

There are some general goals students should try to attain during their off-campus field experience that are specific to the practice of athletic training. In addition, there may be opportunities for learning aspects of athletic training that are not available at all on- and off-campus sites. Athletic Training Students should set aside some time with their ACI/S to discuss the general goals (listed below) to meet during their field experience. At that time, Athletic Training Students and their ACI/S should also establish a list of goals that are specific to the affiliated site and determine together their objectives for attaining each goal.

My strengths with regards to athletic training at this time are:

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My weaknesses with regards to athletic training at this time are:

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My goals for this clinical rotation are:

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The specific skills/techniques that I would like to work on and develop throughout this clinical experience are:

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Has this form has been discussed with my ACI? Yes No

Students Electronic Signature:       Date: 

ACI/S's Electronic Signature:       Date: