Physical Therapy and Rehabilitation Sciences: DPT Clinical Education Forms

Clinical Education Manual

Please download, complete and email or fax the following forms to:

Patricia P. Rubertone, MPT, MSW
Assistant Professor and Academic Coordinator of Clinical Education
Drexel University
Programs in Physical Therapy & Rehabilitation Sciences
245 N. 15th Street, MS 502
Philadelphia, PA 19102-1192
Tel: 215-762-4166
Fax: 215-762-3886

• Clinical Education Request Form
  
  
• Clinical Internship Student Data Sheet
  
  
• Emergency Contact Information Form
  
  
• Evaluation of Clinical Site Assignment Process
  
  
• Preliminary Information for Possible Clinical Affiliation Sites ("Set up" Form)
  
  
• Clinical Site Contact Information Form
  
  
• Clinical Education I Student Data Sheet
  
  
• Clinical Education II and III Student Data Sheet
  
  
• Student Evaluation of the Clinical Experience
  
  
• Student Profile and Questionnaire
  
  
• PT Essential Functions
  
  All documents are in .PDF format, please download Adobe Acrobat Reader to view these documents.