EmailMe Form - Remedial Application Request in Meditrek

Student Name *
First Last
Student ID *
Walden University Student E-mail Address *

Confirm E-mail
Current Program: *
Current Specialization: *
Academic term for which you will be logging practicum hours for the Incomplete Grade (current term you need to log hours not the term you received the incomplete grade): *
Academic Year for which you will be logging practicum hours for the Incomplete Grade (e.g. 2020, 2021): *
Practicum Course Number for which you will be logging practicum hours for the Incomplete Grade:
State/Country Where Practicum Will Occur: *
I verify that I have an Incomplete Grade and I am eligible for a remedial application. I understand that remedial applications are only for students that need to complete practicum hours from the last term with an Incomplete Grade. *
Yes
I understand that I must receive practicum approval for this remedial application in Meditrek prior to logging practicum hours: *
Yes
No
I understand that I must have all my onboarding requirements updated in CastleBranch in order to be approved for this term, including Professional Liabilty Insurance: *
Yes - All my onboarding requirements are updated in CastleBranch.
Yes - I am working on updating my onboarding requirements in CastleBranch.
No
Additional Comments (Optional):
Please use this section to provide additional details about the change needed or any comments.