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.

I. Student Overall Assessment (
Completed by Student)

My overall impression of why I performed below standard is/are: (Check all that apply)

Test Taking Errors: 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. ________________________________________________

II. Areas of Opportunity based on Pre-Predictor Results (
Completed by Faculty)

Faculty and student will meet to discuss specifics

1._______________________________________________________________________________________

2._______________________________________________________________________________________

3._______________________________________________________________________________________

4._______________________________________________________________________________________

5._______________________________________________________________________________________

6.________________________________________________________________________________________

7.________________________________________________________________________________________

8._______
_________________________________________________________________________________

9.________________________________________________________________________________________

10._______________________________________________________________________________________

Recommended Individualized Student Plan with specific details

__Develop a Calendar/Schedule for Weekly Review ________________________________________

__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 _________________________________________________________

__Other resources: ___________________________________________________________________

___________________________________________________________________________________

Students should document their activities based on the area identified above in II. Areas of Opportunity

V. Completion of Individual Success Plan
(Completed by Faculty with Student) DUE Week 10

__ Yes, all specific areas of opportunity were completed

__ No, success plan was not completed

Comments: _____________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

Faculty Signature: ___________________________________________Date: _________________

Student Signature: ___________________________________________Date: _________________

IV. Student Outcome for each area of focus/topic/concept (
Completed by Student) Use a separate sheet as needed.

Students should document their detailed review activities as identified above.

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.

Preceptor Signature: ________________________________________________________Date: ___________

Student Signature: __________________________________________________________Date: ___________

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