University of North Florida
Physical Therapy Internship Experience
Remediation Plan
Clinical Practicum/Internship _____________
Name: ______________________________________
Date: ______________________________________
Site of Clinical Experience: ______________________________________
I recognize that I did not pass my clinical experience listed above. I understand that my
weaknesses pertained to the following items on the CPI. (Use attached sheet as needed.)
I acknowledge that prior to being assigned to another clinical site. I must improve in the
areas listed above. My plan to improve includes the following: (Use attached sheet as
needed.)
Action Plan(s)
Time Line
Student Signature and Date _________________________________________
ACCE Approval of Action Plan.
Signature and Date _______________________________________________
Once I believe I have satisfactorily completed the action plan(s) listed above I will
schedule a meeting with my ACCE and provide documentation of such completion. If
the ACCE agrees with my assessment he/she will work with me to establish a new
clinical experience. If he/she disagrees, I may be required to complete additional work
prior to placement. I understand that once I am assigned to a site, the CCCE at that site
will be informed that I am repeating this clinical experience.
Appendix E