Transcription of SUPERVISOR EVALUATION FORM - americanmedtech.org
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SUPERVISOR EVALUATION FORM - americanmedtech.org
10700 W. Higgins Road Suite 150, Rosemont, Illinois 60018 Voice: 847-823-5169 Fax: 847-789-9414 Email: Updated 01/2018 SUPERVISOR EVALUATION FORM From: Instructor SUPERVISOR Evaluator Name: _____ Organization: _____ Address: _____ City: _____ State: _____ Zip: _____ _____ Applicant Name (please print) AMT ID Number (if known) AMT has received an application for certification from the above-named applicant. Your cooperation in evaluating this candidate for certification with American Medical Technologists will be appreciated. Did the applicant receive this experience in school? Yes No AND Did the applicant successfully complete the academic course of instruction?
10700 W. Higgins Road Suite 150, Rosemont, Illinois 60018 – Voice: 847-823-5169 – Fax: 847-789-9414 Email: documents@americanmedtech.org – www.americanmedtech.org
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