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Professional Practice Dimension: _____________________________________________________________   

Area: _________________________

Competency to be addressed and page number from TAP 21: _____________________________________________________________________

Strengths: ______________________________________________________________________________

______________________________________________________________________________

Challenges/Concerns: ______________________________________________________________________________

______________________________________________________________________________

Present level of proficiency from rating forms

     1      2      3      4      5

Level of proficiency to be achieved with this learning plan

        1      2      3      4      5      6

Date of completion of this plan

What is the issue:

Indicate the knowledge, skill and attitudes issues to be addressed

             Goal

What is to be accomplished?

Activities necessary to achieve the goal

What will be done?

                Metrics

How will progress be measured?

   Completion Date

Date for goal completion

Knowledge:

Skill:

Attitude:

Additional comments: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

1/1/09 Version

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