Develop knowledge in selecting and implementing appropriate screening instrument(s), interpreting results, and making recommendations and referrals.

 

 	


Part 3: Projected Timeline/Schedule

Estimate how many hours you expect to work on your Practicum each week. *Note: All of your hours and activities must be supervised by your Preceptor and completed onsite. Your Preceptor will approve all hours, but your activities will be approved by both your Preceptor and Instructor. Any changes to this plan must be approved.

This timeline is intended as a planning tool; your actual schedule may differ from the projections you are making now.

I intend to complete the 144 or 160 Practicum hours (as applicable) according to the following timeline/schedule. I also understand that I must see at least 80 patients during my practicum experience. I understand that I may not complete my practicum hours sooner than 8 weeks. I understand I may not be in the practicum setting longer than 8 hours per day unless pre-approved by my faculty.




Number of Clinical Hours Projected for Week (hours you are in Practicum Setting at your Field Site)
Number of Weekly Hours for Professional Development (these are not practicum hour)
Number of Weekly Hours for Practicum Coursework (these are not practicum hours)




Week 1





Week 2





Week 3





Week 4





Week 5





Week 6





Week 7





Week 8





Week 9





Week 10





Week 11





Total Hours (must meet the following requirements)
144 or 160 Hours





Part 4 – Signatures

Student Signature (electronic):                                           Date:

Practicum Faculty Signature (electronic)**:                                 Date:

** Faculty signature signifies approval of Practicum Experience Plan (PEP)

Submit your Practicum Experience Plan on or before Day 7 of Week 2 for faculty review and approval.

Once approved, you will receive a copy of the PEP for your records. You must share an approved copy with your Preceptor. The Preceptor is not required to sign this form.