NPTE APPEALS for candidates who have failed the exam at least 6 times:

Pique, Homer B. - PT Exam - Education: 1. Pique - Summary of exam takes 2. NPTE Appeal Form - Pique 3. Pique - Statement to Board 4. FSBPT Score Re ort 1126/2017

Foreign (Philippines (J-1 ) (J 2-3) (J 4-5) (16

ED's Recommendation:

- Exam Attem ts: 6

10

NPTE Appeal- Board Meeting - March 15, 2017

Applicant: Pique, Homer B. - PT Exam Education: Foreign (Philippines)

Exam Attempt: 6 (2-TN) (3-FL) (l-NC)

Exam Date: Exam State Score

08/25/2008 TN 523

10/23/2008 TN 558

05/25/2011 FL 569

09/07/2011 FL 566

10/30/2013 FL 527

01126/2017 NC 595

fsbpt

NPTE Appeal Form The only exception to the eligibility requirements will be at the explicit request of a state licensing authority. FSBPT will accept an appeal to the policy for ONE additional attempt from a state on behalf of a candidate who is seeking licensure in that state.

CANDIDATE SECTION (candidate must complete and send to JURISDICTION) Candidate Name: tiOMi=R .5. Pt&llle FSBPTID: OCOOr.3~ Exam level: Dlfl'T o PTA Policy Being Appealed: cY6-time lifetime limit - A candidate is ineligible to take the NPTE if the

candidate has made six or more prior attempts to pass that exam level. o 2 very low scores - A candidate is ineligible to take the NPTE if the candidate has two scores at or below 400 on a given exam level.

State in which you are NO~-n-t G,ARou NA seeking licensure: Reason for appeal: f'-e;ASt:; ~~e=- A-i\~~ ~~.

EXAMINATION INFORMATION Exam level (PT/PTA) Date State Score (If known)

t>\ stJ?-& toe TN ..0:2.3 PI J 0/;2.3 / oe TN 55g IT s'Ju'l/l_ FL- 5c;Q f'\ q / =r» f'L- .5~C- FT /0/30/ /3 -Fl- 15:2-=r PI J l;).~ /It- NG 8q,s;

DISCIPLINE INFORMATION - Has any state or FSBPT taken a disciplinary action or issued you a sanction? Action Taken Date State Explanation

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Candidate Attestation: The information I have provided a the state in w

is accurate and I meet all the licensure requirements for

Date: _ __;re=-=+-!...::::;.og'="'I--/..:...-lI-T~ _

RISDICTION IN WHICH YOU ARE SEEKING LICENSURE TO INQUIRE AS TO WHO THE CORRECT CONTACT IS TO PROCESS AN APPEAL ON YOUR BEHALF. ( http://www . fsbpt. org/FreeResources/LicensingAuthoritiesContactl nformation.aspx)

fsbpt

LICENSING AUTHORITY SECTION (To be completed by Administrator or Board Chair) Background information When did this candidate first seek licensure in your state? What evidence do you have that the candidate intends to practice in your state? Has the state imposed a remediation requirement for this candidate? At what point in the process was remediation required? Reason for Requesting Appeal

0 Candidate was attending PT/PTA school (receiving a second entry level degree) during the notification period (October 2014 - December 2015)

0 Candidate was not an active test taker after January 2011 (i.e., was not notified) 0 State law requires an additional attempt be granted

Citation: 0 Other

Rationale:

Licensing Authority Attestation; I have reviewed the individual's prior examination history. S/he is eligible to sit for the exam and meets all licensure requirements and will be eligible for licensure in this jurisdiction if s/he passes the NPTE. I certify that I am authorized to present this request on behalf of the physical therapy licensing authority.

Name: _

Signature: _

Title: _

Date: _

JURISDICTIONS - PLEASE EMAIL THIS FORM TO appeals@fsbpt.org

Letter of Appeal

February 21,2017 NOIth Carolina Board of Physical Therapy Examiners 18 West Colony Place, Suite 140 Durham, NC 27705

Dear North Carol ina Board of PT,

I would like to thank you for the chance and opportunity in accepting my application as a PT applicant. As a husband and father offive it has been my dream to provide the best for my family. I have made the sacrifice to leave them to fulfill my obligations by passing the NPTE. I am writing this letter because if there's even a small chance of your approval, I would gladly take the time to make my appeal and humbly accept your decision. It's been a long journey for me in taking the NPTE examination. Kindly take this moment to read about my experiences in taking the examination. I have always been an achiever in my academic career and after being blessed with a wife and loving children, my focus turned to providing the best life that I can for them. In trying to provide the best life that I can, I knew that becoming a Physical Therapist in the US would provide the best opportunities for myself and family.

My 1st NPTE was taken August 25,2008, and my score was 523 without attending any formal review. [was supposed to stay for a month and go back home, but because of limited financial support and time constraint, I was forced to file my resignation from St. Luke's Medical Center as a Physical Therapist under the Physical Rehabilitation Department, This was a decision to take the October 23,2008 exam. I tried again and got the score of 558. I was really hoping to pass the test. Especially considering the fact that my family was relying on me. Dealing with the struggle of wanting academic excellence and passing the exam was mixed with the emotions of knowing that I was the sole provider for my family. Loneliness from being away with my wife and kids, and the pressure offailing the exam added to my stress. The NPTE was the first professional exam that I have failed to pass. Failing this exam took a toll on my confidence. I quickly identified that there was something wrong with my preparation in taking the examination. I knew that I needed to re­ evaluate my studying habits and skills in order to try and pass the exam. Having to go home with a burden on my shoulder of not passing the exam as well as still having to financially support my family, it took me years to be confident again in myself. I had to regain the confidence to succeed and to find the will to want to continue in my journey and conquer my ultimate goal which was to come to the United States and make a better life for us.

About three years later, I took the examination on May 25,20 II, and got a score of 569. After failing for the third time, my anxiety in taking the exam was really getting to me. My previous employer advised me to take the September 7, 20 II, as my 4th attempt. Although I felt some reservations, I took their advice and attempted again. I was still having difficulty in analyzing the problems with the exam due to past experiences and pressures to pass. Unfortunately I scored a 566. Even with the several attempts, I still maintained the drive to take the exam again. I shifted gears in my studying and confidence which led me to take the exam for 5th attempt on October 30,2013.

When [ took my y" examination I received a score of 527.Not only was [ dealing with the disappointment of the exam results, my wife was dealing with a high risk pregnancy with our youngest child. I was managing between my two jobs to sustain our financial needs, taking care of my family and reviewing for my test on my own. I was not prepared mentally, especially with the financial constraint and domestic problems. I knew that it would affect my examination, but I was really determined to attain my goal.

After 2 years of waiting and changing employers my EB2 visa was granted. I was given another chance to take the exam. I am very fortunate to have been able to attend the review class of IER and I took the PEAT (review materials) with good results. I was now in a better place with the right study tools given, and assistance from my employer which was enabling me to focus on the goal at hand; to pass the NPTE. I was extremely confident that I would pass my 6th attempt. It was a make it or break it for me and that added more tension in my test taking strategy. I have studied hard over the past several months and have dedicated myself to the exam. r have complied with everything asked of me. I have sacrificed leaving my family to come here for the exam with the hopes that this time will be different. I knew that with the right help and support I would pass the exam. AliI want to do is practice Physical Therapy and help people the way I have been helped. I want to make a difference in the world, starting with my own family. I want my kids to thank me later for giving them a better life. I want to make my wife proud of who she married. I want nothing but the opportunity to make that difference not only in my life and my family's but in the lives of those who can use the skills I have as a Physical Therapist. It may seem small but to me it is something great.! understand that everyone has struggles and hardships so I am not asking to have a pardon at life. What I am asking is to be given another opportunity. I have failed the exam again on January 26th, 2017 with the score of 595. I was 5 points away from accomplishing my goals. Failure is not an option, however in this case the only thing hindering me from success is the rule implemented that someone can only take the exam 6 times. I understand that they have implemented this rule for a reason and I respect that reason, however at my most vulnerable time I am asking for an exception.

With this letter, I am humbly asking you to please consider my appeal, to allow me in taking the NPTE again. I am prepared to take any remediation actions from you. I have come a long way and I am hoping to have another chance to prove myself especially to my family that I am not a failure. My hope is still high because I know can be of great service as a physical therapist. My willingness to improve myself and to impart whatever learnings and experiences J had made will remain as I pursue my career. Your decision will inspire me to strive harder on this examination.

fsbpt PIQUE, HOMER BUSI

FSBPT ID: 0000736

Date of Birth: 1/17/1972

PT 1/26/2017

FAILED 595

6 ATTEMPT(S)

LICENSES (NO LICENSES REPORTED)

Jurisdiction NORTH CAROLINA

Sitting ID •• ···3073

Graduation Date March 1994

School (5905) Emilio Aguinaldo College

Address 1359 EAST SAMPLE ROAD POMPANO BEACH, FL 33064 POMPANO BEACH, FL 33064

Email HPIQUE@GMAIL.COM

ADVERSE ACTIONS (NO ACTIONS REPORTED)

ADDITIONAL INFORMATION Passed? Passing the NPTE does not mean that you are licensed to practice. You must receive notification of licensure from the jurisdiction to which you applied. For information on our continuing competence resources and steps on how to become licensed in another state visit: http://wvwv.fsbpt.org/Licensees/ContinLlingCompetence.aspx

Need to test again? Get information on retaking the exam and resources to help you improve your performance. http://wvwv.fshpt.org/ExamCandidates/NationaIExam(NPTE)/RetakeExam.aspx

Tba Federation of State Boards of Fhysicallrerapy 1124 'Mlst Street &luth Third Roor Alexandria, VA 223141 (703) 739-9420 1 www.fsbpt.orq