Student Remediation Documentation, Tracking, and Annual Audit Form ARC-PA Alignment: Standard A3.16(c), A3.16(d), A3.16(e), and A3.16(f). Related Program Processes: Student Performance, Student Progression, Remediation, Professionalism, Academic Records, and Program Completion. Record Classification: Confidential Student Educational Recor d. This is the Program’s official remediation record and supersedes the quick- reference summary above whenever the two forms would conflict. Section I. Student and Remediation Identification Student Name / NLU ID / Cohort/Graduation Class: _______________________________________________________ Date Concern Identified / Date Remediation Initiated: _______________________________________________________ Course/Clinical Experience/Program Area: _______________________________________________________ Type of r emediation (check all that apply): Didactic/Academic Performance; Knowledge Deficiency; Clinical Skills Performance; Clinical Reasoning; Professionalism; Communication; Documentation; SCPE/Clinical Performance; Summative Assessment; Program Competency; Program Learning Outcome; Examination Performance; Technical/Procedural Skill; Other. Reason for Remediation: _______________________________________________________ Section II. Identification of Performance Deficiency Applicable Requirement/Standard: _______________________________________________________ Expected Performance: _______________________________________________________ Student's Actual Performance: _______________________________________________________ Assessment or evidence demonstrating defici ency (check all that apply): Examination Score; Practical Examination; OSCE; Clinical Skills Assessment; Faculty Evaluation; Preceptor Evaluation; SCPE Evaluation; Professionalism Evaluation; Competency Assessment; Programmatic Assessment; Attendance/Participation Documentation; Other.
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