NR631 W1 Learning Agreement Template for Jenae H 1 1 .docx

Chamberlain College of Nursing NR631 Nurse Executive Track—CGE I
L
EARNING
A
GREEMENT
Student name: Jenae
Hutsell
Student D#: D41044640
Student e-mail, phone:
[email protected] , 859-550-6185
Mentor name and credentials:
Diana Hampton, MSN
Mentor contact information (work phone, cell phone, e-mail and work address):
Work: 859-233-4511 ext : 3746
Cell Phone: [phone]
Email: [email protected]
Work email: [email protected]
Directions:
For Week 1, complete the Learning Agreement with self-identified goals to meet Course
Outcomes (COs) and initial plans to meet those self-identified goals; review the TIPS document
to help you and discuss your goals and plans with your mentor. Your mentor must sign the
Learning Agreement for your Week 1 submission.
The agreement should be revised each week to reflect completed goals, additional goals, and
changes to the plan dictated by the actual experience or revisions suggested by faculty or the
mentor. At the end of the practicum experience, evaluate success with your mentor and obtain
the mentor’s signature at the bottom of agreement. Save this form as a Word document and
enter required information directly onto it; submit the completed Learning Agreement, signed by
your mentor, on the Saturday of Week 8. See the Learning Agreement Grading Rubric for
grading details.
The Learning Agreement consists of three sections.
I. Student Learning Outcomes table (Week 1)
II. Signatures approving plan (Week 1)
III. Signatures and mentor verification (Week 8)
Due Dates:
1. Initial signed Learning Agreement is submitted by 11:59 p.m. MT, Sunday at the end of Week 1