DPT Remediation Plan

Student Name:*

First NameLast Name

Student Email:*

example@example.com

Course Name:*

Semester:

Academic Year:

Type of Assessment:

Assessment Name (from syllabus):

Assessment Name *

(from syllabus)

If 'other', please list here:

Assessment Grade:*

Date of Assessment/Due Date:

Date

Name of Faculty Overseeing Remediation (Course Director):*

Email of Faculty Overseeing Remediation:*

example@example.com

Who is your Faculty Advisor?*

Faculty Advisor Email*

Date Review Sheet Completed:

Date

If "other" please provide details here:

Question Profile

Other comments/concerns:

Optional document upload:

If you have any forms you would like to submit to faculty, please do so here.

My identified area(s) of weakness(s) include:

I understand the self-study remediation plan to include the following tasks:

I agree to complete the self-study remediation plan by:

Date

I agree to take the reassessment/reevaluation by:

Date

Hour MinutesAM/PM Option

I was provided the opportunity to review the assessment which was judged to be below the established passing threshold. The course faculty member and/or course director has explained to me the rationale for the portions of the assessment that were below threshold level. Based upon my self-reflection, I recognize the above noted weaknesses in my performance. This has enabled me to suggest the remedial actions that I have listed above. I will complete remediation as approved by the course faculty member and/or course director. I understand that failure to complete the remediation plan by the above indicated time and date will result in a failed remediation attempt and further remediation may not be permitted for the assessment indicated above.

I understand the remediation process and reflection is to help ensure student learning and success as I navigate through the program in order to assist in acquiring the knowledge and means necessary to pass the NPTE upon graduation.

By signing below, I agree to this statement.

Student Signature:*

Today's Date:

Date

Students, please select 'Submit for Faculty Review'. The 'Next' page is for Faculty only.

Assessment Analysis Review Sheet

Remediation Summary/Outcome Form

Action