Purpose: To guide students as they prepare to participate in the LSC PT Clinic’s Outreach Program.  This plan is focused toward projects that address injury prevention, but can be modified for projects with another focus.

Guidelines:
1. This form must be completed and returned to Chandra Shoberg (or supervising faculty member for this project) prior to your presentation dry run.
2.  Feedback will be given and should be incorporated prior to your dry run. It should also be incorporated into your actual presentation. Failure to address and utilize feedback given may result in an unsatisfactory grade on your presentation.
3.  The dry run must be completed at least one week prior to the date of your actual presentation.
4.  A faculty member must observe the dry run.

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Student name(s)__________________________________Today’s Date____________

Audience for Outreach Training: (who/how many?)____________________________________

Proposed training date (should not be less than 10 days from the date this form reaches the instructor):

_________________________________________________________________________________

Proposed training location (include building and city – projects outside of Duluth or Superior will only be approved in special circumstances):

__________________________________________________________________________________________

Training contact person (full name):___________________________________________________

Training details: 

1. specific roles for each member of your group

 

2. plan for an introduction, including purpose/goals for the project/presentation

 

3. review of relevant anatomy as appropriate

 

4. demonstration of correct techniques

 

5. time for practice as appropriate

 

6. clear summary of presentation or results

 

7. audio and/or visual aids to be used

 

8. what handouts will be provided

 

9. other

Training goals for the students/presenters: List at least three (3) outcomes you hope to accomplish with your training. For examples of how to write outcomes, see any PTA program course syllabus.

1.

2.

3.

 

Training goals for the audience or beneficiary: List at least three (3) outcomes you intend for the audience.

1.

2.

3.

 

Other details not included above:

 

 

 

Instructor comments:

 

 

 

Instructor Approval: ____yes ______no

Conditions of approval (if any):

 

 

Date reviewed by instructor: