Executive summary feedback form

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Share your written proposal with your manager, supervisor, or other colleague in a formal leadership position within a health care organization. Complete the “Executive Summary Feedback Form,” located in topic Resources, during the exchange and submit the document.

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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