Internship Coordinator Feedback Form
Complete all the fields as required. (Attach all the Lists as required)
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Email *
Internship Coordinator's Name & KMPDB Reg No. *
1. Medical Internship Centres
2. Dental Internship Centres
Internship Period (Start) *
MM
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DD
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YYYY
Internship Period (End) *
MM
/
DD
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YYYY
Number of Interns *
Number of Interns Assessed *
Number of Interns Successful *
Number of Interns Retained (have pending weeks) *
Supervising Specialist(s) Present - Full Names and KMPDB Registration Number *
Supervising Specialist(s) - Full Names and KMPDB Registration Number *
Outcome *
Rate Rotation *
What are the reported issues in the Internship Centre *
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