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Bureau of Professional Licensing PO Box 30670 Lansing MI 48909 517 335-0918 www. michigan.gov/bpl BPLHelp michigan.gov PHYSICAL THERAPIST OR PHYSICAL THERAPIST ASSISTANT EXPERIENTIAL ACTIVITY FORM Authority 1978 PA 368 as amended An Evaluative Component for Professional Development Requirement PDR Credits earned under Activity Code 14. If necessary attach additional pages. LARA/BPL-PTEXPERIENTIALACTIVITY 04/2017 Page 1 of 2 The Department of Licensing and Regulatory Affairs will not...
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How to fill out experiential activity form

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Step 1: Start by gathering all the necessary information and documents related to the experiential activity that you want to fill out the form for.
02
Step 2: Begin by providing your personal information in the required fields. This may include your full name, contact details, and any other relevant identification information.
03
Step 3: Next, provide details about the experiential activity itself. This may involve mentioning the nature of the activity, the location, duration, and any other relevant information.
04
Step 4: If applicable, include any supporting documents or evidence related to the experiential activity. This could be in the form of certificates, letters of recommendation, or any other relevant proof of participation or achievement.
05
Step 5: Review the completed form to ensure all the provided information is accurate and complete. Make any necessary corrections or additions.
06
Step 6: Finally, sign and submit the filled-out experiential activity form as per the instructions provided. Keep a copy of the form for your records.

Who needs experiential activity form?

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Students who participate in internships, co-op programs, or other experiential learning activities may need to fill out an experiential activity form.
02
Educational institutions, such as colleges or universities, often require students to complete and submit an experiential activity form to document their participation in such activities.
03
Employers or organizations offering internships or experiential learning opportunities may also require individuals to fill out an experiential activity form to track their involvement and evaluate their performance.
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In some cases, individuals seeking professional development or accreditation may need to fill out an experiential activity form to demonstrate their practical experience in a certain field.
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Experiential activity form is a document used to report hands-on learning experiences.
Students who are participating in experiential learning activities are required to file the form.
The form can be filled out online or by hand, providing details about the learning experience.
The purpose of the form is to document and track experiential learning opportunities for students.
Information such as the type of activity, duration, location, and learning outcomes must be reported on the form.
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