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Executive Summary Feedback Form
Student Name:__________________
Section & Faculty
Name:_________________________________
Date of Interview:________________
Provider Information
Employee Name :
Last
First
M.I.
Credentials:
Title:
(I.e. MS, RN, etc.)
Organization:
Phone Number:
E-mail Address:
Feedback Section
The RN to BSN program at Grand Canyon University meets the
requirements for clinical competencies as defined by CCNE and
AACN using non-traditional experiences for practicing nurses.
These experiences come in the form of direct and indirect care
experiences in which licensed nursing students engage in
learning within the context of their hospital organization, their
specific care discipline and their local communities.
This activity is intended to foster demonstration of skills related
to leadership and management.
Share your written proposal with your manager, supervisor or
other colleague in a formal leadership position within a health
care organization. Request their feedback using the following
questions as prompts:
1.
Do you believe the proposal would be approved if formally
proposed?
2.
What are some strengths and weaknesses of the proposal?
_______________________________
_________________
Signature of Individual Providing Feedback
Date Signed
NOTE:
Acknowledgement form is to be returned to the student for
electronic submission to the faculty member via the learning
management system (LoudCloud).

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Executive Summary Feedback FormStudent Name_________.docx

  • 1. Executive Summary Feedback Form Student Name:__________________ Section & Faculty Name:_________________________________ Date of Interview:________________ Provider Information Employee Name : Last First M.I. Credentials: Title: (I.e. MS, RN, etc.) Organization: Phone Number: E-mail Address:
  • 2. Feedback Section The RN to BSN program at Grand Canyon University meets the requirements for clinical competencies as defined by CCNE and AACN using non-traditional experiences for practicing nurses. These experiences come in the form of direct and indirect care experiences in which licensed nursing students engage in learning within the context of their hospital organization, their specific care discipline and their local communities. This activity is intended to foster demonstration of skills related to leadership and management. Share your written proposal with your manager, supervisor or other colleague in a formal leadership position within a health care organization. Request their feedback using the following questions as prompts: 1. Do you believe the proposal would be approved if formally proposed? 2. What are some strengths and weaknesses of the proposal? _______________________________ _________________ Signature of Individual Providing Feedback Date Signed NOTE: Acknowledgement form is to be returned to the student for
  • 3. electronic submission to the faculty member via the learning management system (LoudCloud).