Individual Success Plan (including Pre and Post Conference documentation)
Course #­­­­ ____801/801A_____
Target Practice Hours______ (
Based on individual hours required to total 1,000 post-baccalaureate hours.
Please refer to your course syllabus regarding hours built into your specific class.
Please note, some students require more hours based on what they transferred in.
Please contact your SSA for incoming hours.)

P R A C T I C E I M M E R S I O N	Complete Contact Information
	Learner Information	GCU
	Name:
	E-mail:
	Phone Number:
	Course Faculty/Chair  Information	GCU
	Name:
	E-mail:
	Phone Number:
	Mentor/Content Expert/Preceptor  Information	Practice Setting
	Name:
	E-mail:
	Phone Number:

Updates and Modifications to this Individual Success Plan:  Always check the DC Network for updated versions of this plan for each course.

Instructions

Use this form to develop your Individual Success Plan (ISP) for each course, starting in DNP-805 through graduation. An individual success plan maps out what you, the DNP Learner, needs to accomplish in order to be successful in your current course and overall program of study. You will also share this document with your mentor, preceptor, or content expert (CE) at the beginning of week one (like a pre-conference) and by the end of week eight of each course (like a post-conference).

DNP 820 Implementation Into Practice GCU

In addition to the ISP, all DNP learners in DNP-815, 815A, DNP-830, 830A, DNP-840, 840A, DNP-955, 955A, DNP-960, 960A, DNP-965, 965A, and extension courses will schedule a mid-conference between the faculty/Chair, mentor (preceptor), and learnerr before week five.  This mid-conference document is located at the end of the ISP and will be uploaded into the week five dropbox. Learners will type their names, and the mentor, preceptor, or CE will need to electronically sign with software that uses a displayed digital identifier or written signature.

Application-based learning assignments are listed in specific course syllabus. Use the syllabus as a reminder for you to complete a weekly corresponding Case Log in Typhon or into Lopes tracker. It is the learner’s responsibility to enter the hours into Typhon/Lopestracker and ensure all hours are signed off before completion of the course.  Faculty are not responsible to go back and approve hours later entered. Any independent study assignments in this course will require your collaboration with the course faculty and mentor, preceptor, or CE early on to establish a plan for successful completion of mutually identified and agreed upon deliverables and must relate to your current course objectives. Independent study assignments must be submitted to your instructor via the Private Forum if no dropbox is available.

For you to successfully complete and graduate from the DNP Program you must meet the following programmatic requirements: (1) completion of required practice immersion hours, (2) completion of work associated with all DNP and GCU program competencies, (3) successful defense and completion of your Direct Practice Improvement Project including signature by the Dean. DNP Learners who are deficient in hours or have a final manuscript deemed “not ready” for Dean’s review at the end of the program may require additional extension courses to meet programmatic requirements prior to Dean’s approval.

The syllabus will list the immersion hours for each course and may be different based on the curriculum.  For example, DNP-815 may state 50 hours, while DNP-815 (A) is 100 hours broken down into “Direct” or “Indirect” immersion” hours.  Direct hours are completed at the project site with the mentor. Indirect hours are used towards assignments, as the syllabus indicates.  All actual hours are recorded into Typhon or Lopestracker substantively. Note that required practice hours vary from learner to learner and are determined by your MSN transcripts. Please contact your SSC for the number of practice immersion hours required to complete your DNP program. It is your responsibility to obtain this information and create a plan for your individual success.

ISP Table Requirements

Use the following information to ensure successful completion of the assignment as it pertains to deliverables due in this course:

• Review the DNP Program Milestones document in the DC Network – Doctoral Program – DNP Program Materials – Folder – DPI Milestones. Please see the DNP Program Timeline in the DC Network for a quick overview.

• Determine what practice experiences you plan to seek in order to address each course objective. Include the estimated number of associated practice immersion hours. Learners will apply objectives and concepts from each of their courses to reflect upon, critically examine, and improve current practice and are required to integrate scholarly readings to develop case reports that demonstrate increasingly complex and proficient practice.

• Use the ISP to develop a personal plan for completing your practice immersion hours and self-assess how you will meet the GCU DNP Domains & Competencies (Appendix A) related to that course. Show all the major milestones (if applicable) and deliverables. ISPs do not earn practice hours, nor does telephone conference time, or time spent with the mentor (unless there is National Emergency). Add your pre-, mid-, and post-conference dates and times to this document to ensure you have scheduled the time properly. 

The table below should address the following programmatic requirements: (1) completion of required practice immersion hours, (2) completion of work associated with all DNP and GCU program competencies, (3) successful defense, and completion of your Direct Practice Improvement Project, if applicable to the current course.

Application Based Learning Course Assignments,Independent Study, Project Site Visits Challenges (list under assignment)	Number of Planned Immersion Hours Associated with each Assignment/Project Site	Date Due	Review Course Objectives and GCU DNP Domains & Competencies. Create a plan for the practice experiences you plan to seek in order to address each course objective. Consider how each assignment may relate back to your current project concept.	Self-Assessed GCU DNP Domains & Competencies (see appendix)	Actual Practice Immersion Hours Completed Associated with each assignment (blank until end-of-course)	Date Complete
Programmatic Planning for DPI project See DNP Program Milestones document in the DC Network	Number of Planned Immersion Hours Associated with each Assignment/Project Site	Date Due	Summary of Past Feedback	Self-Assessed GCU DNP Domains & Competencies (see appendix)	Actual Practice Immersion Hours Completed Associated with each assignment (blank until end-of-course)	Date Complete

Direct Practice Improvement Project Planning and Progression

Elements of the design, development, and construction of the DPI project are integrated throughout the program curriculum. As you progress through the courses, use the following form to document your progress and preparation for the DPI project.

Intended Site for DPI (Make sure this is approved through OFE)	GCU
Site Name:
Does your site have an IRB and or QI process? If yes, what is the process? Create a plan (including a timeline) for preparing for site QI/IRB requirements.*
Contact Information:
PICOT Question	Department Feedback
Name:
E-mail:		Date:
Phone Number:
Mentor, Preceptor, or Content Expert  Information	Practice Setting
Name:
E-mail:
Phone Number:

Note: Learners should not recruit, implement, or collect data until after both site and GCU QI/IRB designations have been given. GCU QI/IRB occurs in DNP-960.

By typing in his/her signature below, the learner agrees to have read, understood, and be accountable for the instructions, assignments, and hours are shown above and that all questions have been satisfactorily answered by the faculty and/or program lead. Additionally, the learner agrees to provide the mentor, preceptor, or content expert (depending on the course) with a copy of the syllabus for the course at or before the time of signature Mentors, preceptors, or content experts will sign digitally or by wet ink upon initial receipt and at the end of the course to confirm that assignments have been complete with your guidance.

Learner Signature:
Name:
Date:
Mentor, Preceptor, or Content Expert Signature [Upon Starting the Course: DUE WEEK 1]
Name:
Date:
Mentor, Preceptor, or Content Expert Signature [Upon Completion of Course: DUE WEEK 8]
Name:
Date:

Digital signatures with identifiers are accepted or wet ink.

For the Mentor (Preceptor): By initialing below, I signify that I have received the following information from my student and/or through preceptor orientation training before the course:

_____ Copy of or link to Graduate Field Experience Manual                       _____ I understand I must complete the course specific evaluations

_____ Copy of or link to the University Policy Handbook                             _____ Instructions for GCU Practicum/Clinical Tracking System

_____ Faculty Contact Information

Mentor-Faculty-Student Conference and Evaluation Information

A pre- and post-conference or evaluation between students and their mentors (preceptors) are mandatory for students enrolled in all DNP courses 801 -840 and 801A-965A including extension courses.  This will be considered completed using the Individual Success Plan. Conferences may be conducted face-to-face or via technology. A signature (Electronic with a digital identifier or wet signature) is required from the mentor (preceptor) during the pre- and post-conference periods. The ISP is to be uploaded into the appropriate drop boxes by the due date.

A pre, mid, and post-conference or evaluation between students, faculty, and preceptors are mandatory for students enrolled in all DNP project courses (DNP-815, 815A, DNP-830, 830A, DNP-840, 840A, DNP-955, 955A, DNP-960, 960A, DNP-965, 965A, and extension courses). Conferences may be conducted face-to-face or via technology. A copy of this signed document will be uploaded into the course shell no later than the end of week five in the project courses.

Overall Course and Student Specific Objectives: These objectives should be discussed during each conference, as students are responsible for completing all experiences as mandated for the program.

A pre-conference: This meeting is intended for the student and mentor (preceptor) to review course and student-specific learning objectives: the roles, responsibilities, and expectations of student and mentor (preceptor) during this immersion experience.   All faculty and mentor (preceptor) information will be given to each party per the student.  Any course or program information requested by the mentor (preceptor) will be provided by the student. During this meeting, the student and mentor (preceptor) will discuss the course and immersion goals, including any projects that are to take place. The faculty will review the submitted document and need to approve proposed projects at this time. The faculty will also send an introductory email to the mentor (preceptor).

A mid-term conference  is mandatory and will occur no later than week five of all project courses DNP-815, 815A, DNP-830, 830A, DNP-840, 840A, DNP-955, 955A, DNP-960, 960A, DNP-965, 965A, and extension courses. This meeting is intended for the student, faculty, and mentor (preceptor) to discuss student progress toward meeting the course goals.  The faculty member will meet with the preceptor to conduct the student’s midterm evaluation (virtually). The mentor (preceptor) will meet with the student to review the evaluation form (in person or virtually). If there are areas that need improvement, the faculty will meet with the student to complete a remediation form.

A post-conference, is mandatory and will occur at the end of each course beginning in DNP-805 through graduation using the ISP Form. This is intended for the student and mentor (preceptor) to review and evaluate the completion of the ISP.  The faculty will validate that all areas are at “meets expectations” on the mentor evaluation form located in Typhon or Lopestracker prior to progression. The learner will upload the ISP and Mentor evaluation, and proof of entered and approved immersion hours into the course drop boxes by week eight with the other required deliverables. Faculty will review this before filling out the Faculty evaluation of the learner in Typhon, which the learner will also upload in week eight. The course faculty completes a separate evaluation of the learner’s performance in the classroom. The faculty is responsible for any course grading, final course grade, and validation of the students’ completed practicum hours.

GCU CONHCP Additional Immersion Hours

Directions: Please include all information requested on this form in all sections. This form must be uploaded into Typhon or Lopes Activity Tracker at the end of every course signed by your mentor.  Additionally all activities must be added to the ISP and uploaded by day they are completed.  Example: If the learner attended an Evidenced-based Practice Conference for eight (8) hours, the conference objectives must be uploaded with the hours requested.  Learners in DNP 801-840 cannot gain more than 20 hours per course, no more than 720 minutes (12 hours/day). All other DNP Learners DNP 801A-965A are prescribed hours by course and therefore are not eligible to gain these hours.

Date of Activity	**Type of Immersion Hour Experience	Immersion Hour Activity	# of Hours (max 12 per day)

Mentor/Content Expert Signature: _______________________________________ Date:__________________   Total Hours: ___________

I attest by my signature that the learner obtained all of these hours outlined on this document.

Individual Success Plan (including Pre and Post Conference documentation)

Course #­­­­ __805/805A_______

Target Practice Hours______ (Based on individual hours required to total 1,000 post-baccalaureate hours. Please refer to your course syllabus regarding hours built into your specific class. Please note, some students require more hours based on what they transferred in. Please contact your SSA for incoming hours.)

P R A C T I C E I M M E R S I O N	Complete Contact Information
	Learner Information	GCU
	Name:
	E-mail:
	Phone Number:
	Course Faculty/Chair  Information	GCU
	Name:
	E-mail:
	Phone Number:
	Mentor/Content Expert/Preceptor  Information	Practice Setting
	Name:
	E-mail:
	Phone Number:

Updates and Modifications to this Individual Success Plan:  Always check the DC Network for updated versions of this plan for each course.

The table below should address the following programmatic requirements: (1) completion of required practice immersion hours, (2) completion of work associated with all DNP and GCU program competencies, (3) successful defense, and completion of your Direct Practice Improvement Project, if applicable to the current course.

Application Based Learning Course Assignments,Independent Study, Project Site Visits Challenges (list under assignment)	Number of Planned Immersion Hours Associated with each Assignment/Project Site	Date Due	Review Course Objectives and GCU DNP Domains & Competencies. Create a plan for the practice experiences you plan to seek in order to address each course objective. Consider how each assignment may relate back to your current project concept.	Self-Assessed GCU DNP Domains & Competencies (see appendix)	Actual Practice Immersion Hours Completed Associated with each assignment (blank until end-of-course)	Date Complete
Programmatic Planning for DPI project See DNP Program Milestones document in the DC Network	Number of Planned Immersion Hours Associated with each Assignment/Project Site	Date Due	Summary of Past Feedback	Self-Assessed GCU DNP Domains & Competencies (see appendix)	Actual Practice Immersion Hours Completed Associated with each assignment (blank until end-of-course)	Date Complete

Direct Practice Improvement Project Planning and Progression

Elements of the design, development, and construction of the DPI project are integrated throughout the program curriculum. As you progress through the courses, use the following form to document your progress and preparation for the DPI project.

Intended Site for DPI (Make sure this is approved through OFE)	GCU
Site Name:
Does your site have an IRB and or QI process? If yes, what is the process? Create a plan (including a timeline) for preparing for site QI/IRB requirements.*
Contact Information:
PICOT Question	Department Feedback
Name:
E-mail:		Date:
Phone Number:
Mentor, Preceptor, or Content Expert  Information	Practice Setting
Name:
E-mail:
Phone Number:

Note: Learners should not recruit, implement, or collect data until after both site and GCU QI/IRB designations have been given. GCU QI/IRB occurs in DNP-960.

By typing in his/her signature below, the learner agrees to have read, understood, and be accountable for the instructions, assignments, and hours as shown above and that all questions have been satisfactorily answered by the faculty and/or program lead. Additionally, the learner agrees to provide the mentor, preceptor, or content expert (depending on the course) with a copy of the syllabus for the course at or before the time of signature. Mentors, preceptors, or content experts will sign digitally or by wet ink upon initial receipt and at the end of the course to confirm that assignments have been complete with your guidance.

Learner Signature:
Name:
Date:
Mentor, Preceptor, or Content Expert Signature [Upon Starting the Course: DUE WEEK 1]
Name:
Date:
Mentor, Preceptor, or Content Expert Signature [Upon Completion of Course: DUE WEEK 8]
Name:
Date:

Digital signatures with identifiers are accepted or wet ink.

For the Mentor (Preceptor): By initialing below, I signify that I have received the following information from my student and/or through preceptor orientation training before the course:

_____ Copy of or link to Graduate Field Experience Manual                       _____ I understand I must complete the course specific evaluations

_____ Copy of or link to the University Policy Handbook                             _____ Instructions for GCU Practicum/Clinical Tracking System

_____ Faculty Contact Information

GCU CONHCP Additional Immersion Hours

Directions: Please include all information requested on this form in all sections. This form must be uploaded into Typhon or Lopes Activity Tracker at the end of every course signed by your mentor.  Additionally all activities must be added to the ISP and uploaded by day they are completed.  Example: If the learner attended an Evidenced-based Practice Conference for eight (8) hours, the conference objectives must be uploaded with the hours requested. Learners in DNP 801-840 cannot gain more than 20 hours per course, no more than 720 minutes (12 hours/day). All other DNP Learners DNP 801A-965A are prescribed hours by course and therefore are not eligible to gain these hours.

Date of Activity	**Type of Immersion Hour Experience	Immersion Hour Activity	# of Hours (max 12 per day)

Mentor/Content Expert Signature: _______________________________________ Date:__________________   Total Hours: ___________

I attest by my signature that the learner obtained all of these hours outlined on this document.

Individual Success Plan (including Pre and Post Conference documentation)

Course #­­­­ __810/810A________

Target Practice Hours______ (Based on individual hours required to total 1,000 post-baccalaureate hours. Please refer to your course syllabus regarding hours built into your specific class. Please note, some students require more hours based on what they transferred in. Please contact your SSA for incoming hours.)

P R A C T I C E I M M E R S I O N	Complete Contact Information
	Learner Information	GCU
	Name:
	E-mail:
	Phone Number:
	Course Faculty/Chair  Information	GCU
	Name:
	E-mail:
	Phone Number:
	Mentor/Content Expert/Preceptor  Information	Practice Setting
	Name:
	E-mail:
	Phone Number:

Updates and Modifications to this Individual Success Plan:  Always check the DC Network for updated versions of this plan for each course.

The table below should address the following programmatic requirements: (1) completion of required practice immersion hours, (2) completion of work associated with all DNP and GCU program competencies, (3) successful defense, and completion of your Direct Practice Improvement Project, if applicable to the current course.

Application Based Learning Course Assignments,Independent Study, Project Site Visits Challenges (list under assignment)	Number of Planned Immersion Hours Associated with each Assignment/Project Site	Date Due	Review Course Objectives and GCU DNP Domains & Competencies. Create a plan for the practice experiences you plan to seek in order to address each course objective. Consider how each assignment may relate back to your current project concept.	Self-Assessed GCU DNP Domains & Competencies (see appendix)	Actual Practice Immersion Hours Completed Associated with each assignment (blank until end-of-course)	Date Complete
Programmatic Planning for DPI project See DNP Program Milestones document in the DC Network	Number of Planned Immersion Hours Associated with each Assignment/Project Site	Date Due	Summary of Past Feedback	Self-Assessed GCU DNP Domains & Competencies (see appendix)	Actual Practice Immersion Hours Completed Associated with each assignment (blank until end-of-course)	Date Complete

Direct Practice Improvement Project Planning and Progression

Elements of the design, development, and construction of the DPI project are integrated throughout the program curriculum. As you progress through the courses, use the following form to document your progress and preparation for the DPI project.

Intended Site for DPI (Make sure this is approved through OFE)	GCU
Site Name:
Does your site have an IRB and or QI process? If yes, what is the process? Create a plan (including a timeline) for preparing for site QI/IRB requirements.*
Contact Information:
PICOT Question	Department Feedback
Name:
E-mail:		Date:
Phone Number:
Mentor, Preceptor, or Content Expert  Information	Practice Setting
Name:
E-mail:
Phone Number:

Note: Learners should not recruit, implement, or collect data until after both site and GCU QI/IRB designations have been given. GCU QI/IRB occurs in DNP-960.

By typing in his/her signature below, the learner agrees to have read, understood, and be accountable for the instructions, assignments, and hours are shown above and that all questions have been satisfactorily answered by the faculty and/or program lead. Additionally, the learner agrees to provide the mentor, preceptor, or content expert (depending on the course) with a copy of the syllabus for the course at or before the time of signature Mentors, preceptors, or content experts will sign digitally or by wet ink upon initial receipt and at the end of the course to confirm that assignments have been complete with your guidance.

Learner Signature:
Name:
Date:
Mentor, Preceptor, or Content Expert Signature [Upon Starting the Course: DUE WEEK 1]
Name:
Date:
Mentor, Preceptor, or Content Expert Signature [Upon Completion of Course: DUE WEEK 8]
Name:
Date:

Digital signatures with identifiers are accepted or wet ink.

For the Mentor (Preceptor): By initialing below, I signify that I have received the following information from my student and/or through preceptor orientation training before the course:

_____ Copy of or link to Graduate Field Experience Manual                       _____ I understand I must complete the course specific evaluations

_____ Copy of or link to the University Policy Handbook                             _____ Instructions for GCU Practicum/Clinical Tracking System

_____ Faculty Contact Information

GCU CONHCP Additional Immersion Hours

Directions: Please include all information requested on this form in all sections. This form must be uploaded into Typhon or Lopes Activity Tracker at the end of every course signed by your mentor.  Additionally all activities must be added to the ISP and uploaded by day they are completed.  Example: If the learner attended an Evidenced-based Practice Conference for eight (8) hours, the conference objectives must be uploaded with the hours requested.  Learners in DNP 801-840 cannot gain more than 20 hours per course, no more than 720 minutes (12 hours/day). All other DNP Learners DNP 801A-965A are prescribed hours by course and therefore are not eligible to gain these hours.

Date of Activity	**Type of Immersion Hour Experience	Immersion Hour Activity	# of Hours (max 12 per day)

Mentor/Content Expert Signature: _______________________________________ Date:__________________   Total Hours: ___________

I attest by my signature that the learner obtained all of these hours outlined on this document.

Individual Success Plan (including Pre and Post Conference documentation)

Course #­­­­ __815/ 815A________

Target Practice Hours______ (Based on individual hours required to total 1,000 post-baccalaureate hours. Please refer to your course syllabus regarding hours built into your specific class. Please note, some students require more hours based on what they transferred in. Please contact your SSA for incoming hours.)

P R A C T I C E I M M E R S I O N	Complete Contact Information
	Learner Information	GCU
	Name:
	E-mail:
	Phone Number:
	Course Faculty/Chair  Information	GCU
	Name:
	E-mail:
	Phone Number:
	Mentor/Content Expert/Preceptor  Information	Practice Setting
	Name:
	E-mail:
	Phone Number:

Updates and Modifications to this Individual Success Plan:  Always check the DC Network for updated versions of this plan for each course.

The table below should address the following programmatic requirements: (1) completion of required practice immersion hours, (2) completion of work associated with all DNP and GCU program competencies, (3) successful defense, and completion of your Direct Practice Improvement Project, if applicable to the current course.

Application Based Learning Course Assignments,Independent Study, Project Site Visits Challenges (list under assignment)	Number of Planned Immersion Hours Associated with each Assignment/Project Site	Date Due	Review Course Objectives and GCU DNP Domains & Competencies. Create a plan for the practice experiences you plan to seek in order to address each course objective. Consider how each assignment may relate back to your current project concept.	Self-Assessed GCU DNP Domains & Competencies (see appendix)	Actual Practice Immersion Hours Completed Associated with each assignment (blank until end-of-course)	Date Complete
Programmatic Planning for DPI project See DNP Program Milestones document in the DC Network	Number of Planned Immersion Hours Associated with each Assignment/Project Site	Date Due	Summary of Past Feedback	Self-Assessed GCU DNP Domains & Competencies (see appendix)	Actual Practice Immersion Hours Completed Associated with each assignment (blank until end-of-course)	Date Complete

Direct Practice Improvement Project Planning and Progression

Elements of the design, development, and construction of the DPI project are integrated throughout the program curriculum. As you progress through the courses, use the following form to document your progress and preparation for the DPI project.

Intended Site for DPI (Make sure this is approved through OFE)	GCU
Site Name:
Does your site have an IRB and or QI process? If yes, what is the process? Create a plan (including a timeline) for preparing for site QI/IRB requirements.*
Contact Information:
PICOT Question	Department Feedback
Name:
E-mail:		Date:
Phone Number:
Mentor, Preceptor, or Content Expert  Information	Practice Setting
Name:
E-mail:
Phone Number:

Note: Learners should not recruit, implement, or collect data until after both site and GCU QI/IRB designations have been given. GCU QI/IRB occurs in DNP-960.

By typing in his/her signature below, the learner agrees to have read, understood, and be accountable for the instructions, assignments, and hours are shown above and that all questions have been satisfactorily answered by the faculty and/or program lead. Additionally, the learner agrees to provide the mentor, preceptor, or content expert (depending on the course) with a copy of the syllabus for the course at or before the time of signature Mentors, preceptors, or content experts will sign digitally or by wet ink upon initial receipt and at the end of the course to confirm that assignments have been complete with your guidance.

Learner Signature:
Name:
Date:
Mentor, Preceptor, or Content Expert Signature [Upon Starting the Course: DUE WEEK 1]
Name:
Date:
Mentor, Preceptor, or Content Expert Signature [Upon Completion of Course: DUE WEEK 8]
Name:
Date:

Digital signatures with identifiers are accepted or wet ink.

For the Mentor (Preceptor): By initialing below, I signify that I have received the following information from my student and/or through preceptor orientation training before the course:

_____ Copy of or link to Graduate Field Experience Manual                       _____ I understand I must complete the course specific evaluations

_____ Copy of or link to the University Policy Handbook                             _____ Instructions for GCU Practicum/Clinical Tracking System

_____ Faculty Contact Information

Mid-term conference: Student-Faculty-Mentor (preceptor)

Review progress towards meeting goals/objectives with rationales provided by the student at the mid-term conference:

Project updates: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Concerns: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Preceptor Signature: ________________________________________              Date: _______________

Student Signature: ________________________________________              Date: _______________

Please upload to the week five dropbox as indicated in the syllabus

GCU CONHCP Additional Immersion Hours

Directions: Please include all information requested on this form in all sections. This form must be uploaded into Typhon or Lopes Activity Tracker at the end of every course signed by your mentor.  Additionally all activities must be added to the ISP and uploaded by day they are completed.  Example: If the learner attended an Evidenced-based Practice Conference for eight (8) hours, the conference objectives must be uploaded with the hours requested.  Learners in DNP 801-840 cannot gain more than 20 hours per course, no more than 720 minutes (12 hours/day). All other DNP Learners DNP 801A-965A are prescribed hours by course therefore do not eligible to gain these hours.

Date of Activity	**Type of Immersion Hour Experience	Immersion Hour Activity	# of Hours (max 12 per day)

Mentor/Content Expert Signature: _______________________________________ Date:__________________   Total Hours: ___________

I attest by my signature that the learner obtained all of these hours outlined on this document.

Individual Success Plan (including Pre and Post Conference documentation)

Course #­­­­ __820/820A_______

Target Practice Hours______ (Based on individual hours required to total 1,000 post-baccalaureate hours. Please refer to your course syllabus regarding hours built into your specific class. Please note, some students require more hours based on what they transferred in. Please contact your SSA for incoming hours.)

P R A C T I C E I M M E R S I O N	Complete Contact Information
	Learner Information	GCU
	Name:
	E-mail:
	Phone Number:
	Course Faculty/Chair  Information	GCU
	Name:
	E-mail:
	Phone Number:
	Mentor/Content Expert/Preceptor  Information	Practice Setting
	Name:
	E-mail:
	Phone Number:

Updates and Modifications to this Individual Success Plan:  Always check the DC Network for updated versions of this plan for each course.

The table below should address the following programmatic requirements: (1) completion of required practice immersion hours, (2) completion of work associated with all DNP and GCU program competencies, (3) successful defense, and completion of your Direct Practice Improvement Project, if applicable to the current course.

Application Based Learning Course Assignments,Independent Study, Project Site Visits Challenges (list under assignment)	Number of Planned Immersion Hours Associated with each Assignment/Project Site	Date Due	Review Course Objectives and GCU DNP Domains & Competencies. Create a plan for the practice experiences you plan to seek in order to address each course objective. Consider how each assignment may relate back to your current project concept.	Self-Assessed GCU DNP Domains & Competencies (see appendix)	Actual Practice Immersion Hours Completed Associated with each assignment (blank until end-of-course)	Date Complete
Programmatic Planning for DPI project See DNP Program Milestones document in the DC Network	Number of Planned Immersion Hours Associated with each Assignment/Project Site	Date Due	Summary of Past Feedback	Self-Assessed GCU DNP Domains & Competencies (see appendix)	Actual Practice Immersion Hours Completed Associated with each assignment (blank until end-of-course)	Date Complete

Direct Practice Improvement Project Planning and Progression

Elements of the design, development, and construction of the DPI project are integrated throughout the program curriculum. As you progress through the courses, use the following form to document your progress and preparation for the DPI project.

Intended Site for DPI (Make sure this is approved through OFE)	GCU
Site Name:
Does your site have an IRB and or QI process? If yes, what is the process? Create a plan (including a timeline) for preparing for site QI/IRB requirements.*
Contact Information:
PICOT Question	Department Feedback
Name:
E-mail:		Date:
Phone Number:
Mentor, Preceptor, or Content Expert  Information	Practice Setting
Name:
E-mail:
Phone Number:

Note: Learners should not recruit, implement, or collect data until after both site and GCU QI/IRB designations have been given. GCU QI/IRB occurs in DNP-960.

By typing in his/her signature below, the learner agrees to have read, understood, and be accountable for the instructions, assignments, and hours are shown above and that all questions have been satisfactorily answered by the faculty and/or program lead. Additionally, the learner agrees to provide the mentor, preceptor, or content expert (depending on the course) with a copy of the syllabus for the course at or before the time of signature Mentors, preceptors, or content experts will sign digitally or by wet ink upon initial receipt and at the end of the course to confirm that assignments have been complete with your guidance.

Learner Signature:
Name:
Date:
Mentor, Preceptor, or Content Expert Signature [Upon Starting the Course: DUE WEEK 1]
Name:
Date:
Mentor, Preceptor, or Content Expert Signature [Upon Completion of Course: DUE WEEK 8]
Name:
Date:

Digital signatures with identifiers are accepted or wet ink.

For the Mentor (Preceptor): By initialing below, I signify that I have received the following information from my student and/or through preceptor orientation training before the course:

_____ Copy of or link to Graduate Field Experience Manual                       _____ I understand I must complete the course specific evaluations

_____ Copy of or link to the University Policy Handbook                             _____ Instructions for GCU Practicum/Clinical Tracking System

_____ Faculty Contact Information

GCU CONHCP Additional Immersion Hours

Directions: Please include all information requested on this form in all sections. This form must be uploaded into Typhon or Lopes Activity Tracker at the end of every course signed by your mentor.  Additionally all activities must be added to the ISP and uploaded by day they are completed.  Example: If the learner attended an Evidenced-based Practice Conference for eight (8) hours, the conference objectives must be uploaded with the hours requested.  Learners in DNP 801-840 cannot gain more than 20 hours per course, no more than 720 minutes (12 hours/day). All other DNP Learners DNP 801A-965A are prescribed hours by course therefore do not eligible to gain these hours.

Date of Activity	**Type of Immersion Hour Experience	Immersion Hour Activity	# of Hours (max 12 per day)

Mentor/Content Expert Signature: _______________________________________ Date:__________________   Total Hours: ___________

I attest by my signature that the learner obtained all of these hours outlined on this document.

Individual Success Plan (including Pre and Post Conference documentation)

Course #­­­­ __825/825A________

Target Practice Hours______ (Based on individual hours required to total 1,000 post-baccalaureate hours. Please refer to your course syllabus regarding hours built into your specific class. Please note, some students require more hours based on what they transferred in. Please contact your SSA for incoming hours.)

P R A C T I C E I M M E R S I O N	Complete Contact Information
	Learner Information	GCU
	Name:
	E-mail:
	Phone Number:
	Course Faculty/Chair  Information	GCU
	Name:
	E-mail:
	Phone Number:
	Mentor/Content Expert/Preceptor  Information	Practice Setting
	Name:
	E-mail:
	Phone Number:

Updates and Modifications to this Individual Success Plan:  Always check the DC Network for updated versions of this plan for each course.

The table below should address the following programmatic requirements: (1) completion of required practice immersion hours, (2) completion of work associated with all DNP and GCU program competencies, (3) successful defense, and completion of your Direct Practice Improvement Project, if applicable to the current course.

Application Based Learning Course Assignments,Independent Study, Project Site Visits Challenges (list under assignment)	Number of Planned Immersion Hours Associated with each Assignment/Project Site	Date Due	Review Course Objectives and GCU DNP Domains & Competencies. Create a plan for the practice experiences you plan to seek in order to address each course objective. Consider how each assignment may relate back to your current project concept.	Self-Assessed GCU DNP Domains & Competencies (see appendix)	Actual Practice Immersion Hours Completed Associated with each assignment (blank until end-of-course)	Date Complete
Programmatic Planning for DPI project See DNP Program Milestones document in the DC Network	Number of Planned Immersion Hours Associated with each Assignment/Project Site	Date Due	Summary of Past Feedback	Self-Assessed GCU DNP Domains & Competencies (see appendix)	Actual Practice Immersion Hours Completed Associated with each assignment (blank until end-of-course)	Date Complete

Direct Practice Improvement Project Planning and Progression

Elements of the design, development, and construction of the DPI project are integrated throughout the program curriculum. As you progress through the courses, use the following form to document your progress and preparation for the DPI project.

Intended Site for DPI (Make sure this is approved through OFE)	GCU
Site Name:
Does your site have an IRB and or QI process? If yes, what is the process? Create a plan (including a timeline) for preparing for site QI/IRB requirements.*
Contact Information:
PICOT Question	Department Feedback
Name:
E-mail:		Date:
Phone Number:
Mentor, Preceptor, or Content Expert  Information	Practice Setting
Name:
E-mail:
Phone Number:

Note: Learners should not recruit, implement, or collect data until after both site and GCU QI/IRB designations have been given. GCU QI/IRB occurs in DNP-960.

By typing in his/her signature below, the learner agrees to have read, understood, and be accountable for the instructions, assignments, and hours are shown above and that all questions have been satisfactorily answered by the faculty and/or program lead. Additionally, the learner agrees to provide the mentor, preceptor, or content expert (depending on the course) with a copy of the syllabus for the course at or before the time of signature Mentors, preceptors, or content experts will sign digitally or by wet ink upon initial receipt and at the end of the course to confirm that assignments have been complete with your guidance.

Learner Signature:
Name:
Date:
Mentor, Preceptor, or Content Expert Signature [Upon Starting the Course: DUE WEEK 1]
Name:
Date:
Mentor, Preceptor, or Content Expert Signature [Upon Completion of Course: DUE WEEK 8]
Name:
Date:

Digital signatures with identifiers are accepted or wet ink.

For the Mentor (Preceptor): By initialing below, I signify that I have received the following information from my student and/or through preceptor orientation training before the course:

_____ Copy of or link to Graduate Field Experience Manual                       _____ I understand I must complete the course specific evaluations

_____ Copy of or link to the University Policy Handbook                             _____ Instructions for GCU Practicum/Clinical Tracking System

_____ Faculty Contact Information

GCU CONHCP Additional Immersion Hours

Directions: Please include all information requested on this form in all sections. This form must be uploaded into Typhon or Lopes Activity Tracker at the end of every course signed by your mentor.  Additionally all activities must be added to the ISP and uploaded by day they are completed.  Example: If the learner attended an Evidenced-based Practice Conference for eight (8) hours, the conference objectives must be uploaded with the hours requested.  Learners in DNP 801-840 cannot gain more than 20 hours per course, no more than 720 minutes (12 hours/day). All other DNP Learners DNP 801A-965A are prescribed hours by course therefore do not eligible to gain these hours.

Date of Activity	**Type of Immersion Hour Experience	Immersion Hour Activity	# of Hours (max 12 per day)

Mentor/Content Expert Signature: _______________________________________ Date:__________________   Total Hours: ___________

I attest by my signature that the learner obtained all of these hours outlined on this document.

Individual Success Plan (including Pre and Post Conference documentation)

Course #­­­­ __830/830A________

Target Practice Hours______ (Based on individual hours required to total 1,000 post-baccalaureate hours. Please refer to your course syllabus regarding hours built into your specific class. Please note, some students require more hours based on what they transferred in. Please contact your SSA for incoming hours.)

P R A C T I C E I M M E R S I O N	Complete Contact Information
	Learner Information	GCU
	Name:
	E-mail:
	Phone Number:
	Course Faculty/Chair  Information	GCU
	Name:
	E-mail:
	Phone Number:
	Mentor/Content Expert/Preceptor  Information	Practice Setting
	Name:
	E-mail:
	Phone Number:

Updates and Modifications to this Individual Success Plan:  Always check the DC Network for updated versions of this plan for each course.

The table below should address the following programmatic requirements: (1) completion of required practice immersion hours, (2) completion of work associated with all DNP and GCU program competencies, (3) successful defense, and completion of your Direct Practice Improvement Project, if applicable to the current course.

Application Based Learning Course Assignments,Independent Study, Project Site Visits Challenges (list under assignment)	Number of Planned Immersion Hours Associated with each Assignment/Project Site	Date Due	Review Course Objectives and GCU DNP Domains & Competencies. Create a plan for the practice experiences you plan to seek in order to address each course objective. Consider how each assignment may relate back to your current project concept.	Self-Assessed GCU DNP Domains & Competencies (see appendix)	Actual Practice Immersion Hours Completed Associated with each assignment (blank until end-of-course)	Date Complete
Programmatic Planning for DPI project See DNP Program Milestones document in the DC Network	Number of Planned Immersion Hours Associated with each Assignment/Project Site	Date Due	Summary of Past Feedback	Self-Assessed GCU DNP Domains & Competencies (see appendix)	Actual Practice Immersion Hours Completed Associated with each assignment (blank until end-of-course)	Date Complete

Direct Practice Improvement Project Planning and Progression

Elements of the design, development, and construction of the DPI project are integrated throughout the program curriculum. As you progress through the courses, use the following form to document your progress and preparation for the DPI project.

Intended Site for DPI (Make sure this is approved through OFE)	GCU
Site Name:
Does your site have an IRB and or QI process? If yes, what is the process? Create a plan (including a timeline) for preparing for site QI/IRB requirements.*
Contact Information:
PICOT Question	Department Feedback
Name:
E-mail:		Date:
Phone Number:
Mentor, Preceptor, or Content Expert  Information	Practice Setting
Name:
E-mail:
Phone Number:

Note: Learners should not recruit, implement, or collect data until after both site and GCU QI/IRB designations have been given. GCU QI/IRB occurs in DNP-960.

By typing in his/her signature below, the learner agrees to have read, understood, and be accountable for the instructions, assignments, and hours are shown above and that all questions have been satisfactorily answered by the faculty and/or program lead. Additionally, the learner agrees to provide the mentor, preceptor, or content expert (depending on the course) with a copy of the syllabus for the course at or before the time of signature Mentors, preceptors, or content experts will sign digitally or by wet ink upon initial receipt and at the end of the course to confirm that assignments have been complete with your guidance.

Learner Signature:
Name:
Date:
Mentor, Preceptor, or Content Expert Signature [Upon Starting the Course: DUE WEEK 1]
Name:
Date:
Mentor, Preceptor, or Content Expert Signature [Upon Completion of Course: DUE WEEK 8]
Name:
Date:

Digital signatures with identifiers are accepted or wet ink.

For the Mentor (Preceptor): By initialing below, I signify that I have received the following information from my student and/or through preceptor orientation training before the course:

_____ Copy of or link to Graduate Field Experience Manual                       _____ I understand I must complete the course specific evaluations

_____ Copy of or link to the University Policy Handbook                             _____ Instructions for GCU Practicum/Clinical Tracking System

_____ Faculty Contact Information

Mid-term conference: Student-Faculty-Mentor (preceptor)

Review progress towards meeting goals/objectives with rationales provided by the student at the mid-term conference:

Project updates: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Concerns: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Preceptor Signature: ________________________________________              Date: _______________

Student Signature: ________________________________________              Date: _______________

Please upload to the week five dropbox as indicated in the syllabus

GCU CONHCP Additional Immersion Hours

Directions: Please include all information requested on this form in all sections. This form must be uploaded into Typhon or Lopes Activity Tracker at the end of every course signed by your mentor.  Additionally all activities must be added to the ISP and uploaded by day they are completed.  Example: If the learner attended an Evidenced-based Practice Conference for eight (8) hours, the conference objectives must be uploaded with the hours requested.  Learners in DNP 801-840 cannot gain more than 20 hours per course, no more than 720 minutes (12 hours/day). All other DNP Learners DNP 801A-965A are prescribed hours by course therefore do not eligible to gain these hours.

Date of Activity	**Type of Immersion Hour Experience	Immersion Hour Activity	# of Hours (max 12 per day)

Mentor/Content Expert Signature: _______________________________________ Date:__________________   Total Hours: ___________

I attest by my signature that the learner obtained all of these hours outlined on this document.

Individual Success Plan (including Pre and Post Conference documentation)

Course #­­­­ __835/835A________

Target Practice Hours______ (Based on individual hours required to total 1,000 post-baccalaureate hours. Please refer to your course syllabus regarding hours built into your specific class. Please note, some students require more hours based on what they transferred in. Please contact your SSA for incoming hours.)

P R A C T I C E I M M E R S I O N	Complete Contact Information
	Learner Information	GCU
	Name:
	E-mail:
	Phone Number:
	Course Faculty/Chair  Information	GCU
	Name:
	E-mail:
	Phone Number:
	Mentor/Content Expert/Preceptor  Information	Practice Setting
	Name:
	E-mail:
	Phone Number:

Updates and Modifications to this Individual Success Plan:  Always check the DC Network for updated versions of this plan for each course.

The table below should address the following programmatic requirements: (1) completion of required practice immersion hours, (2) completion of work associated with all DNP and GCU program competencies, (3) successful defense, and completion of your Direct Practice Improvement Project, if applicable to the current course.

Application Based Learning Course Assignments,Independent Study, Project Site Visits Challenges (list under assignment)	Number of Planned Immersion Hours Associated with each Assignment/Project Site	Date Due	Review Course Objectives and GCU DNP Domains & Competencies. Create a plan for the practice experiences you plan to seek in order to address each course objective. Consider how each assignment may relate back to your current project concept.	Self-Assessed GCU DNP Domains & Competencies (see appendix)	Actual Practice Immersion Hours Completed Associated with each assignment (blank until end-of-course)	Date Complete
Programmatic Planning for DPI project See DNP Program Milestones document in the DC Network	Number of Planned Immersion Hours Associated with each Assignment/Project Site	Date Due	Summary of Past Feedback	Self-Assessed GCU DNP Domains & Competencies (see appendix)	Actual Practice Immersion Hours Completed Associated with each assignment (blank until end-of-course)	Date Complete

Direct Practice Improvement Project Planning and Progression

Elements of the design, development, and construction of the DPI project are integrated throughout the program curriculum. As you progress through the courses, use the following form to document your progress and preparation for the DPI project.

Intended Site for DPI (Make sure this is approved through OFE)	GCU
Site Name:
Does your site have an IRB and or QI process? If yes, what is the process? Create a plan (including a timeline) for preparing for site QI/IRB requirements.*
Contact Information:
PICOT Question	Department Feedback
Name:
E-mail:		Date:
Phone Number:
Mentor, Preceptor, or Content Expert  Information	Practice Setting
Name:
E-mail:
Phone Number:

Note: Learners should not recruit, implement, or collect data until after both site and GCU QI/IRB designations have been given. GCU QI/IRB occurs in DNP-960.

By typing in his/her signature below, the learner agrees to have read, understood, and be accountable for the instructions, assignments, and hours are shown above and that all questions have been satisfactorily answered by the faculty and/or program lead. Additionally, the learner agrees to provide the mentor, preceptor, or content expert (depending on the course) with a copy of the syllabus for the course at or before the time of signature Mentors, preceptors, or content experts will sign digitally or by wet ink upon initial receipt and at the end of the course to confirm that assignments have been complete with your guidance.

Learner Signature:
Name:
Date:
Mentor, Preceptor, or Content Expert Signature [Upon Starting the Course: DUE WEEK 1]
Name:
Date:
Mentor, Preceptor, or Content Expert Signature [Upon Completion of Course: DUE WEEK 8]
Name:
Date:

Digital signatures with identifiers are accepted or wet ink.

For the Mentor (Preceptor): By initialing below, I signify that I have received the following information from my student and/or through preceptor orientation training before the course:

_____ Copy of or link to Graduate Field Experience Manual                       _____ I understand I must complete the course specific evaluations

_____ Copy of or link to the University Policy Handbook                             ______ Instructions for GCU Practicum/Clinical Tracking System

_____ Faculty Contact Information

GCU CONHCP Additional Immersion Hours

Directions: Please include all information requested on this form in all sections. This form must be uploaded into Typhon or Lopes Activity Tracker at the end of every course signed by your mentor.  Additionally all activities must be added to the ISP and uploaded by day they are completed.  Example: If the learner attended an Evidenced-based Practice Conference for eight (8) hours, the conference objectives must be uploaded with the hours requested.  Learners in DNP 801-840 cannot gain more than 20 hours per course, no more than 720 minutes (12 hours/day). All other DNP Learners DNP 801A-965A are prescribed hours by course therefore do not eligible to gain these hours.

Date of Activity	**Type of Immersion Hour Experience	Immersion Hour Activity	# of Hours (max 12 per day)

Mentor/Content Expert Signature: _______________________________________ Date:__________________   Total Hours: ___________

I attest by my signature that the learner obtained all of these hours outlined on this document.

Individual Success Plan (including Pre and Post Conference documentation)

Course #­­­­ __840/840A________

Target Practice Hours______ (Based on individual hours required to total 1,000 post-baccalaureate hours. Please refer to your course syllabus regarding hours built into your specific class. Please note, some students require more hours based on what they transferred in. Please contact your SSA for incoming hours.)

P R A C T I C E I M M E R S I O N	Complete Contact Information
	Learner Information	GCU
	Name:
	E-mail:
	Phone Number:
	Course Faculty/Chair  Information	GCU
	Name:
	E-mail:
	Phone Number:
	Mentor/Content Expert/Preceptor  Information	Practice Setting
	Name:
	E-mail:
	Phone Number:

Updates and Modifications to this Individual Success Plan:  Always check the DC Network for updated versions of this plan for each course.

The table below should address the following programmatic requirements: (1) completion of required practice immersion hours, (2) completion of work associated with all DNP and GCU program competencies, (3) successful defense, and completion of your Direct Practice Improvement Project, if applicable to the current course.

Application Based Learning Course Assignments,Independent Study, Project Site Visits Challenges (list under assignment)	Number of Planned Immersion Hours Associated with each Assignment/Project Site	Date Due	Review Course Objectives and GCU DNP Domains & Competencies. Create a plan for the practice experiences you plan to seek in order to address each course objective. Consider how each assignment may relate back to your current project concept.	Self-Assessed GCU DNP Domains & Competencies (see appendix)	Actual Practice Immersion Hours Completed Associated with each assignment (blank until end-of-course)	Date Complete
Programmatic Planning for DPI project See DNP Program Milestones document in the DC Network	Number of Planned Immersion Hours Associated with each Assignment/Project Site	Date Due	Summary of Past Feedback	Self-Assessed GCU DNP Domains & Competencies (see appendix)	Actual Practice Immersion Hours Completed Associated with each assignment (blank until end-of-course)	Date Complete

Direct Practice Improvement Project Planning and Progression

Elements of the design, development, and construction of the DPI project are integrated throughout the program curriculum. As you progress through the courses, use the following form to document your progress and preparation for the DPI project.

Intended Site for DPI (Make sure this is approved through OFE)	GCU
Site Name:
Does your site have an IRB and or QI process? If yes, what is the process? Create a plan (including a timeline) for preparing for site QI/IRB requirements.*
Contact Information:
PICOT Question	Department Feedback
Name:
E-mail:		Date:
Phone Number:
Mentor, Preceptor, or Content Expert  Information	Practice Setting
Name:
E-mail:
Phone Number:

Note: Learners should not recruit, implement, or collect data until after both site and GCU QI/IRB designations have been given. GCU QI/IRB occurs in DNP-960.

By typing in his/her signature below, the learner agrees to have read, understood, and be accountable for the instructions, assignments, and hours are shown above and that all questions have been satisfactorily answered by the faculty and/or program lead. Additionally, the learner agrees to provide the mentor, preceptor, or content expert (depending on the course) with a copy of the syllabus for the course at or before the time of signature Mentors, preceptors, or content experts will sign upon initial receipt and at the end of the course to confirm that assignments have been complete with your guidance.

Learner Signature:
Name:
Date:
Mentor, Preceptor, or Content Expert Signature [Upon Starting the Course: DUE WEEK 1]
Name:
Date:
Mentor, Preceptor, or Content Expert Signature [Upon Completion of Course: DUE WEEK 8]
Name:
Date:

Digital signatures with identifiers are accepted or wet ink.

For the Mentor (Preceptor): By initialing below, I signify that I have received the following information from my student and/or through preceptor orientation training before the course:

_____ Copy of or link to Graduate Field Experience Manual                       _____ I understand I must complete the course specific evaluations

_____ Copy of or link to the University Policy Handbook                             _____ Instructions for GCU Practicum/Clinical Tracking System

_____ Faculty Contact Information

Mid-term conference: Student-Faculty-Mentor (preceptor)

Review progress towards meeting goals/objectives with rationales provided by the student at the mid-term conference:

Project updates: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Concerns: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Preceptor Signature: ________________________________________              Date: _______________

Student Signature: ________________________________________              Date: _______________

Please upload to the week five dropbox as indicated in the syllabus

GCU CONHCP Additional Immersion Hours

Directions: Please include all information requested on this form in all sections. This form must be uploaded into Typhon or Lopes Activity Tracker at the end of every course signed by your mentor.  Additionally all activities must be added to the ISP and uploaded by day they are completed.  Example: If the learner attended an Evidenced-based Practice Conference for eight (8) hours, the conference objectives must be uploaded with the hours requested.  Learners in DNP 801-840 cannot gain more than 20 hours per course, no more than 720 minutes (12 hours/day). All other DNP Learners DNP 801A-965A are prescribed hours by course therefore do not eligible to gain these hours.

Date of Activity	**Type of Immersion Hour Experience	Immersion Hour Activity	# of Hours (max 12 per day)

Mentor/Content Expert Signature: _______________________________________ Date:__________________   Total Hours: ___________

I attest by my signature that the learner obtained all of these hours outlined on this document.

Individual Success Plan (including Pre and Post Conference documentation)

Course #­­­­ __955/955A________

Target Practice Hours______ (Based on individual hours required to total 1,000 post-baccalaureate hours. Please refer to your course syllabus regarding hours built into your specific class. Please note, some students require more hours based on what they transferred in. Please contact your SSA for incoming hours.)

P R A C T I C E I M M E R S I O N	Complete Contact Information
	Learner Information	GCU
	Name:
	E-mail:
	Phone Number:
	Course Faculty/Chair  Information	GCU
	Name:
	E-mail:
	Phone Number:
	Mentor/Content Expert/Preceptor  Information	Practice Setting
	Name:
	E-mail:
	Phone Number:

Updates and Modifications to this Individual Success Plan:  Always check the DC Network for updated versions of this plan for each course.

The table below should address the following programmatic requirements: (1) completion of required practice immersion hours, (2) completion of work associated with all DNP and GCU program competencies, (3) successful defense, and completion of your Direct Practice Improvement Project, if applicable to the current course.

Application Based Learning Course Assignments,Independent Study, Project Site Visits Challenges (list under assignment)	Number of Planned Immersion Hours Associated with each Assignment/Project Site	Date Due	Review Course Objectives and GCU DNP Domains & Competencies. Create a plan for the practice experiences you plan to seek in order to address each course objective. Consider how each assignment may relate back to your current project concept.	Self-Assessed GCU DNP Domains & Competencies (see appendix)	Actual Practice Immersion Hours Completed Associated with each assignment (blank until end-of-course)	Date Complete
Programmatic Planning for DPI project See DNP Program Milestones document in the DC Network	Number of Planned Immersion Hours Associated with each Assignment/Project Site	Date Due	Summary of Past Feedback	Self-Assessed GCU DNP Domains & Competencies (see appendix)	Actual Practice Immersion Hours Completed Associated with each assignment (blank until end-of-course)	Date Complete

Direct Practice Improvement Project Planning and Progression

Elements of the design, development, and construction of the DPI project are integrated throughout the program curriculum. As you progress through the courses, use the following form to document your progress and preparation for the DPI project.

Intended Site for DPI (Make sure this is approved through OFE)	GCU
Site Name:
Does your site have an IRB and or QI process? If yes, what is the process? Create a plan (including a timeline) for preparing for site QI/IRB requirements.*
Contact Information:
PICOT Question	Department Feedback
Name:
E-mail:		Date:
Phone Number:
Mentor, Preceptor, or Content Expert  Information	Practice Setting
Name:
E-mail:
Phone Number:

Note: Learners should not recruit, implement, or collect data until after both site and GCU QI/IRB designations have been given. GCU QI/IRB occurs in DNP-960.

By typing in his/her signature below, the learner agrees to have read, understood, and be accountable for the instructions, assignments, and hours are shown above and that all questions have been satisfactorily answered by the faculty and/or program lead. Additionally, the learner agrees to provide the mentor, preceptor, or content expert (depending on the course) with a copy of the syllabus for the course at or before the time of signature Mentors, preceptors, or content experts will sign digitally or by wet ink upon initial receipt and at the end of the course to confirm that assignments have been complete with your guidance.

Learner Signature:
Name:
Date:
Mentor, Preceptor, or Content Expert Signature [Upon Starting the Course: DUE WEEK 1]
Name:
Date:
Mentor, Preceptor, or Content Expert Signature [Upon Completion of Course: DUE WEEK 8]
Name:
Date:

Digital signatures with identifiers are accepted or wet ink.

For the Mentor (Preceptor): By initialing below, I signify that I have received the following information from my student and/or through preceptor orientation training before the course:

_____ Copy of or link to Graduate Field Experience Manual                       _____ I understand I must complete the course specific evaluations

_____ Copy of or link to the University Policy Handbook                             _____ Instructions for GCU Practicum/Clinical Tracking System

_____ Faculty Contact Information

Mid-term conference: Student-Faculty-Mentor (preceptor)

Review progress towards meeting goals/objectives with rationales provided by the student at the mid-term conference:

Project updates: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Concerns: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Preceptor Signature: ________________________________________              Date: _______________

Student Signature: ________________________________________              Date: _______________

Please upload to the week five dropbox as indicated in the syllabus

GCU CONHCP Additional Immersion Hours

Directions: Please include all information requested on this form in all sections. This form must be uploaded into Typhon or Lopes Activity Tracker at the end of every course signed by your mentor.  Additionally all activities must be added to the ISP and uploaded by day they are completed.  Example: If the learner attended an Evidenced-based Practice Conference for eight (8) hours, the conference objectives must be uploaded with the hours requested.  Learners in DNP 801-840 cannot gain more than 20 hours per course, no more than 720 minutes (12 hours/day). All other DNP Learners DNP 801A-965A are prescribed hours by course therefore do not eligible to gain these hours.

Date of Activity	**Type of Immersion Hour Experience	Immersion Hour Activity	# of Hours (max 12 per day)

Mentor/Content Expert Signature: _______________________________________ Date:__________________   Total Hours: ___________

I attest by my signature that the learner obtained all of these hours outlined on this document.

Individual Success Plan (including Pre and Post Conference documentation)

Course #­­­­ __960/960A________

Target Practice Hours______ (Based on individual hours required to total 1,000 post-baccalaureate hours. Please refer to your course syllabus regarding hours built into your specific class. Please note, some students require more hours based on what they transferred in. Please contact your SSA for incoming hours.)

P R A C T I C E I M M E R S I O N	Complete Contact Information
	Learner Information	GCU
	Name:
	E-mail:
	Phone Number:
	Course Faculty/Chair  Information	GCU
	Name:
	E-mail:
	Phone Number:
	Mentor/Content Expert/Preceptor  Information	Practice Setting
	Name:
	E-mail:
	Phone Number:

Updates and Modifications to this Individual Success Plan:  Always check the DC Network for updated versions of this plan for each course.

The table below should address the following programmatic requirements: (1) completion of required practice immersion hours, (2) completion of work associated with all DNP and GCU program competencies, (3) successful defense, and completion of your Direct Practice Improvement Project, if applicable to the current course.

Application Based Learning Course Assignments,Independent Study, Project Site Visits Challenges (list under assignment)	Number of Planned Immersion Hours Associated with each Assignment/Project Site	Date Due	Review Course Objectives and GCU DNP Domains & Competencies. Create a plan for the practice experiences you plan to seek in order to address each course objective. Consider how each assignment may relate back to your current project concept.	Self-Assessed GCU DNP Domains & Competencies (see appendix)	Actual Practice Immersion Hours Completed Associated with each assignment (blank until end-of-course)	Date Complete
Programmatic Planning for DPI project See DNP Program Milestones document in the DC Network	Number of Planned Immersion Hours Associated with each Assignment/Project Site	Date Due	Summary of Past Feedback	Self-Assessed GCU DNP Domains & Competencies (see appendix)	Actual Practice Immersion Hours Completed Associated with each assignment (blank until end-of-course)	Date Complete

Direct Practice Improvement Project Planning and Progression

Elements of the design, development, and construction of the DPI project are integrated throughout the program curriculum. As you progress through the courses, use the following form to document your progress and preparation for the DPI project.

Intended Site for DPI (Make sure this is approved through OFE)	GCU
Site Name:
Does your site have an IRB and or QI process? If yes, what is the process? Create a plan (including a timeline) for preparing for site QI/IRB requirements.*
Contact Information:
PICOT Question	Department Feedback
Name:
E-mail:		Date:
Phone Number:
Mentor, Preceptor, or Content Expert  Information	Practice Setting
Name:
E-mail:
Phone Number:

Note: Learners should not recruit, implement, or collect data until after both site and GCU QI/IRB designations have been given. GCU QI/IRB occurs in DNP-960.

By typing in his/her signature below, the learner agrees to have read, understood, and be accountable for the instructions, assignments, and hours are shown above and that all questions have been satisfactorily answered by the faculty and/or program lead. Additionally, the learner agrees to provide the mentor, preceptor, or content expert (depending on the course) with a copy of the syllabus for the course at or before the time of signature Mentors, preceptors, or content experts will sign digitally or by wet ink upon initial receipt and at the end of the course to confirm that assignments have been complete with your guidance.

Learner Signature:
Name:
Date:
Mentor, Preceptor, or Content Expert Signature [Upon Starting the Course: DUE WEEK 1]
Name:
Date:
Mentor, Preceptor, or Content Expert Signature [Upon Completion of Course: DUE WEEK 8]
Name:
Date:

Digital signatures with identifiers are accepted or wet ink.

For the Mentor (Preceptor): By initialing below, I signify that I have received the following information from my student and/or through preceptor orientation training before the course:

_____ Copy of or link to Graduate Field Experience Manual                       _____ I understand I must complete the course specific evaluations

_____ Copy of or link to the University Policy Handbook                             ______ Instructions for GCU Practicum/Clinical Tracking System

_____ Faculty Contact Information

Mid-term conference: Student-Faculty-Mentor (preceptor)

Review progress towards meeting goals/objectives with rationales provided by the student at the mid-term conference:

Project updates: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Concerns: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Preceptor Signature: ________________________________________              Date: _______________

Student Signature: ________________________________________              Date: _______________

Please upload to the week five dropbox as indicated in the syllabus

GCU CONHCP Additional Immersion Hours

Directions: Please include all information requested on this form in all sections. This form must be uploaded into Typhon or Lopes Activity Tracker at the end of every course signed by your mentor.  Additionally all activities must be added to the ISP and uploaded by day they are completed.  Example: If the learner attended an Evidenced-based Practice Conference for eight (8) hours, the conference objectives must be uploaded with the hours requested.  Learners in DNP 801-840 cannot gain more than 20 hours per course, no more than 720 minutes (12 hours/day). All other DNP Learners DNP 801A-965A are prescribed hours by course therefore do not eligible to gain these hours.

Date of Activity	**Type of Immersion Hour Experience	Immersion Hour Activity	# of Hours (max 12 per day)

Mentor/Content Expert Signature: _______________________________________ Date:__________________   Total Hours: ___________

I attest by my signature that the learner obtained all of these hours outlined on this document.

Individual Success Plan (including Pre and Post Conference documentation)

Course #­­­­ __965/965A________

Target Practice Hours______ (Based on individual hours required to total 1,000 post-baccalaureate hours. Please refer to your course syllabus regarding hours built into your specific class. Please note, some students require more hours based on what they transferred in. Please contact your SSA for incoming hours.)

P R A C T I C E I M M E R S I O N	Complete Contact Information
	Learner Information	GCU
	Name:
	E-mail:
	Phone Number:
	Course Faculty/Chair  Information	GCU
	Name:
	E-mail:
	Phone Number:
	Mentor/Content Expert/Preceptor  Information	Practice Setting
	Name:
	E-mail:
	Phone Number:

Updates and Modifications to this Individual Success Plan:  Always check the DC Network for updated versions of this plan for each course.

The table below should address the following programmatic requirements: (1) completion of required practice immersion hours, (2) completion of work associated with all DNP and GCU program competencies, (3) successful defense, and completion of your Direct Practice Improvement Project, if applicable to the current course.

Application Based Learning Course Assignments,Independent Study, Project Site Visits Challenges (list under assignment)	Number of Planned Immersion Hours Associated with each Assignment/Project Site	Date Due	Review Course Objectives and GCU DNP Domains & Competencies. Create a plan for the practice experiences you plan to seek in order to address each course objective. Consider how each assignment may relate back to your current project concept.	Self-Assessed GCU DNP Domains & Competencies (see appendix)	Actual Practice Immersion Hours Completed Associated with each assignment (blank until end-of-course)	Date Complete
Programmatic Planning for DPI project See DNP Program Milestones document in the DC Network	Number of Planned Immersion Hours Associated with each Assignment/Project Site	Date Due	Summary of Past Feedback	Self-Assessed GCU DNP Domains & Competencies (see appendix)	Actual Practice Immersion Hours Completed Associated with each assignment (blank until end-of-course)	Date Complete

Direct Practice Improvement Project Planning and Progression

Elements of the design, development, and construction of the DPI project are integrated throughout the program curriculum. As you progress through the courses, use the following form to document your progress and preparation for the DPI project.

Intended Site for DPI (Make sure this is approved through OFE)	GCU
Site Name:
Does your site have an IRB and or QI process? If yes, what is the process? Create a plan (including a timeline) for preparing for site QI/IRB requirements.*
Contact Information:
PICOT Question	Department Feedback
Name:
E-mail:		Date:
Phone Number:
Mentor, Preceptor, or Content Expert  Information	Practice Setting
Name:
E-mail:
Phone Number:

Note: Learners should not recruit, implement, or collect data until after both site and GCU QI/IRB designations have been given. GCU QI/IRB occurs in DNP-960.

By typing in his/her signature below, the learner agrees to have read, understood, and be accountable for the instructions, assignments, and hours are shown above and that all questions have been satisfactorily answered by the faculty and/or program lead. Additionally, the learner agrees to provide the mentor, preceptor, or content expert (depending on the course) with a copy of the syllabus for the course at or before the time of signature Mentors, preceptors, or content experts will sign digitally or by wet ink upon initial receipt and at the end of the course to confirm that assignments have been complete with your guidance.

Learner Signature:
Name:
Date:
Mentor, Preceptor, or Content Expert Signature [Upon Starting the Course: DUE WEEK 1]
Name:
Date:
Mentor, Preceptor, or Content Expert Signature [Upon Completion of Course: DUE WEEK 8]
Name:
Date:

Digital signatures with identifiers are accepted or wet ink.

For the Mentor (Preceptor): By initialing below, I signify that I have received the following information from my student and/or through preceptor orientation training before the course:

_____ Copy of or link to Graduate Field Experience Manual                       _____ I understand I must complete the course specific evaluations

_____ Copy of or link to the University Policy Handbook                             _____ Instructions for GCU Practicum/Clinical Tracking System

_____ Faculty Contact Information

Mid-term conference: Student-Faculty-Mentor (preceptor)

Review progress towards meeting goals/objectives with rationales provided by the student at the mid-term conference:

Project updates: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Concerns: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Preceptor Signature: ________________________________________              Date: _______________

Student Signature: ________________________________________              Date: _______________

Please upload to the week five dropbox as indicated in the syllabus

GCU CONHCP Additional Immersion Hours

Directions: Please include all information requested on this form in all sections. This form must be uploaded into Typhon or Lopes Activity Tracker at the end of every course signed by your mentor.  Additionally all activities must be added to the ISP and uploaded by day they are completed.  Example: If the learner attended an Evidenced-based Practice Conference for eight (8) hours, the conference objectives must be uploaded with the hours requested.  Learners in DNP 801-840 cannot gain more than 20 hours per course, no more than 720 minutes (12 hours/day). All other DNP Learners DNP 801A-965A are prescribed hours by course therefore do not eligible to gain these hours.

Date of Activity	**Type of Immersion Hour Experience	Immersion Hour Activity	# of Hours (max 12 per day)

Mentor/Content Expert Signature: _______________________________________ Date:__________________   Total Hours: ___________

I attest by my signature that the learner obtained all of these hours outlined on this document.

APPENDIX A: