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Southern Illinois University School of Medicine

Office of Education and Curriculum

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Y1 Mentor Logs
- CRR
- SSB
- ERG
Y1 Field/Elective Log
- CRR
- SSB
- ERG
Y1 Mentor Evaluation
Y1 Mentor of the Year Nomination
Mentor Experience Signature
Y1 Mentor Log Printout
- CRR
- SSB
- ERG
Y1 Field/Elective Log Printout
- CRR
- SSB
- ERG

Student Activity Documentation

Clinical Encounter Logbook
- Logbook Printout
- Mentor Hours

Student Appointment Signup Page

HII Selectives Signup

Student Evaluations

Resource Session Evaluation -- CRR
Tutor Group Assessment Form--CRR (student)
Tutor Group Assessment Form--CRR (tutor)
Student Evaluation of Facilitator
Student Evaluation of Mentor
Student Evaluation of Unit

Faculty Evaluations

Other Forms

Approval for Elective Course Admission Prior to Year Three

FCM Clerkship

Internal Medicine Clerkship

OB/GYN Clerkship

Pediatrics Clerkship

Psychiatry Clerkship

Surgery Clerkship

Electives

Misc. Forms

Pager Numbers

EVALUATIONS

OTHER FORMS

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Contact Us:

Debra L. Klamen, MD, MHPE (Curriculum Information)
Jean Afflerbach (Web Page)

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