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Student Name: Student ID:
Section 1: Reason for implementation of the Action Plan for Professional Experience Placement (APPEP)
A. Identified Performance Issue
Student previously failed a PEP (attach ‘Notification of Underperformance and Clinical Review Form’).
Provide details:
Student identified as requiring additional support during practical or laboratory classes. Provide
reason:
Student has failed Peer Appraisal of Clinical Skills or OSCE. Provide details:
B. Lengthy delay between Professional Experience Placements
Student has had an intermission of 12 months or more.
Last PEP Date:
Section 2: Action Plan for Professional Experience Placement (APPEP) Confirmation
Student Declaration:
I
agree
to undertake the requirements outlined in section 4 of this Action Plan for
Professional Experience Placement, within the stated timeframes.
Student Name: Signature: Date:
Academic Name: Signature:
Date:
Copy 1: Student Copy 2: Academic (saved electronically as PDF file to Student File)
Section 3: Action Plan for Professional Experience Placement (APPEP) Completion
Academic Declaration: The learning objective/s outlined in section 4 of this Action Plan for Professional
Experience
Placement have /
have not (check one) been achieved within the specified timeframes. The above
named student therefore
has /
has not completed (check one) this learning action plan.
Academic Name:
Signature:
Date:
Nursing and Midwifery
Action Plan for Professional Experience Placement (APPEP)
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