Name: _______________________Course/Section: _______________ Session: _____________
Your Certification Predictor Exam results have identified your areas of strength and challenge areas/opportunities for your enhancement.
Based on your results, an active success plan is required to best support your preparation for the certification exam. Certification examination success requires a strategic plan.
You will partner with your professor to develop and execute an individualized, prescriptive, results-based plan for the specific topics/concepts that need improvement.
My overall impression of why I performed below standard is/are: (Check all that apply)
Test Taking Errors:Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Knowledge Deficit:
__I misunderstood the questions.                      __I did not remember/know subject content.
__I read into the question.                                __I did not read/engage in the assigned materials.
__I missed important keywords.                       __I did not understand/comprehend subject content.
__I changed the answer.                                   __I did not apply a rationale for the answer.
__I marked the answer incorrectly.                   Other (specify): ___________________________________
__I ran out of time.                                          ________________________________________________
__I did not read all the responses carefully.       ________________________________________________
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Faculty and student will meet to discuss specifics
1._______________________________________________________________________________________
2._______________________________________________________________________________________
3._______________________________________________________________________________________
4._______________________________________________________________________________________
5._______________________________________________________________________________________
6.________________________________________________________________________________________
7.________________________________________________________________________________________
8.________________________________________________________________________________________
9.________________________________________________________________________________________
10._______________________________________________________________________________________
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III. Prescriptive Success Plan (Completed by Faculty)
Recommended Individualized Student Plan with specific details
__Develop a Calendar/Schedule for Weekly Review ________________________________________Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â
__Focus area or System-specific Modules _________________________________________________
__Specific Practicum experiential learning with Preceptor (Short Form attached) _________________
__Reading list (i.e. Textbook/chapter, other resources) _______________________________________
__Review Evidence Based Practice Guidelines _____________________________________________
__Test taking Strategies, specific resources used (i.e. test item keywords, etc.) ____________________
__MyQBank questions, specific systems/populations ________________________________________
__Case Studies (focus area specific, across the lifespan) ______________________________________
__Subject specific online CE modules ____________________________________________________
__Live Review Course (South University or other) __________________________________________
__Apps with Review questions _________________________________________________________
ÂÂ__Other resources: ___________________________________________________________________
___________________________________________________________________________________
Students should document their activities based on the area identified above in II. Areas of Opportunity
Date | Area of Focus | Â Â Â Â Â Â Â Â Â Â Â Â Â Â Detailed Description of Activity of Review
Individual Success Plan |
Time spent |
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Satisfactory Completion of the Success Plan: Individual Success Plan
 __ Yes, all specific areas of opportunity were completed
 __ No, success plan was not completed
Comments: _____________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Faculty Signature: ___________________________________________Date: _________________
Student Signature: ___________________________________________Date: _________________Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â
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Date | Area of Focus | Â Â Â Â Â Â Â Â Â Â Â Â Â Â Detailed Description of Activity of Review
Individual Success Plan |
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Preceptor and Practicum Support Form
Name: ____________________________________________ Course/Section: __________________________
Preceptor Name: ___________________________Practicum Site Name: ______________________________
Location: _____________________________________Course Faculty: _______________________________
Your recent Certification Predictor Exam results identify areas of strength and areas that need strategic focus necessary for certification exam success. Based on your results, an active success plan is required to best support your preparation for the certification exam. You will partner with you professor and preceptor to formulate an individualized, prescriptive, results-based plan for the specific topics/concepts that need improvement.
Date | Area of Focus | Description of In-depth Review (please be specific) |
Individual Success Plan | ||
 Preceptor Signature: ________________________________________________________Date: ___________
 Student Signature: __________________________________________________________Date: ___________
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