Occupational Therapy Assistant Program Application Packet · Occupational Therapy Assistant Program...

Occupational Therapy Assistant Program

Occupational Therapy Assistant Program Application Packet

Rev. 7.12.17 1.


Dear Future Clinician,

Thank you for taking the first step in changing your life by seeking interest into the Occupational Therapy Assistant program at Mountain View College!! We appreciate your interest and look forward to serving your educational needs into this exciting career!

The material included in this packet will describe the admissions process to Mountain View College Occupational Therapy Assistant program and all the forms needed for application to the program.

Mountain View College Occupational Therapy Assistant program is 24 months in length and leads to an Associates in Applied Science Degree (A.A.S.O.T.A) and prepares the graduate to take the National Board for Certification in Occupational Therapy (NBCOT) national examination to become a certified occupational therapy assistant (COTA). Graduates also meet the requirements for state licensure.

Admission to the OTA Program is a separate procedure from admission to Mountain View College. Applicants must meet all the admission criteria for Mountain View College before submitting an application to the OTA program. The program is highly competitive as we are accepting between 14 students into the program this year. Admission to the OTA Program will be made on the applicant’s ranking through a point system.

The application process this year will begin March 1st and end April 27th 2018 (please refer to OTA website for exact dates). Applications will be accepted beginning March 2nd and must be delivered by April 27, 2018. If you have questions about the occupational therapy assistant program or the admissions process, please contact Dr. Candice Freeman (Program Director-Occupational Therapy Assistant Program 214-860-3605 or email her at [email protected] . We look forward to working with you.

Sincerely,

Occupational Therapy Assistant Program Faculty

Rev. 7.12.17 2.

mailto:[email protected]


General Information

ACCREDITATION

The curriculum is designed to meet the standards of the Accreditation Council for Occupational Therapy Education (ACOTE). ACOTE can be contacted at: Accreditation Council for Occupational Therapy Education, c/o Accreditation Department, American Occupational Therapy Association, 4720 Montgomery Lane, Suite 200, Bethesda, MD, 20814-3449, Phone: (301) 652-2682 (AOTA). The website for ACOTE is www.acoteonline.org.

*Mountain View College has been granted Candidacy status to accept students into theOTA program.

LOCATION

Occupational therapy assistant courses are offered only at Mountain View College.

ADMISSION

A new class of students are admitted into the Occupational Therapy Assistant Program each fall. The program will accept 14 students each fall. Current dates for admission can be found in this packet. Late applications or inquiries will not be considered for admission.

PROGRAM COURSES

OTA courses are offered in a set sequence. Once admitted into the program, the student must progress through the curriculum as designed. This means a student cannot “jump” ahead in the curriculum and take advanced occupational therapy assistant courses. Prerequisite courses need to be completed prior to starting the Occupational Therapy Assistant Program.

GRADES

The OTA program will follow the Nursing/Allied Health Department grading system listed below:

92%-100% = A 84%-91.9% = B 75%-83.9% = C 68%-74.9% = D 67% and below= F

Students must earn a “75” or above in all OTA coursework in order to progress in the program.

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http://www.acoteonline.org/


FEES

Students will be responsible for cost of textbooks. An estimated cost of books will be available at boot camp (mandatory attendance required). In addition to books, students are responsible for cost associated with travel to and from fieldwork sites as well as attire for fieldwork. Other fees that students may incur are immunizations, drug screens, and background checks.

DRESS CODE

Student professional dress is expected for all classroom and clinical activities.

CLASSROOM/LEVEL I FIELDWORK: Students are expected to wear orchid scrubs (for ladies) and grape scrubs (for males) (undershirts may be worn), white lab coat, closed toe tennis shoes (slip resistant) and college nametag.

CLINICAL: Level II fieldwork sites usually specify their dress code and the student may have to purchase different sets of attire for each fieldwork. Nametags from either Mountain View College OTA program or the site specific nametag provided to the student should be worn at all times.

*Tattoos should be covered. Jewelry should be simple. Hair is to be neat and pulled back for labs. Students will be asked to wear the designated OTA scrub attire for any community activities unless changes were made by a faculty member of the OTA program.

CRIMINAL HISTORY BACKGROUND CHECK AND DRUG SCREENING

The student will be required to obtain a background check and drug screening to meet requirements of the school and fieldwork education. Additional background checks/drug screenings may be required by fieldwork education sites. Costs associated with additional background checks are the responsibility of the student.

Most states, including Texas, require licensure to practice. Texas licensure is based on successful completion of the NBCOT examination. A felony conviction may affect a graduate's ability to sit for the NBCOT examination or attain state licensure. Any form of charges or conviction results on a criminal background check/drug screening may be cause for exclusion from admission to the program.

If you have been convicted of a misdemeanor (excluding minor traffic violations) or a felony, it is your responsibility to contact the National Board for Certification in Occupational Therapy, Inc. at 301-990-7979, www.nbcot.org AND the Executive Council for Physical Therapy and Occupational Therapy 512-305-6900, www.ecptote.state.tx.us to determine your certification and licensure eligibility. It is you responsibility to have letters of verification sent directly to the program director from each of the above entities noting

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https://na01.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.nbcot.org&data=02%7C01%7CCandiceFreeman%40dcccd.edu%7C20c72343d57742e3892908d4ca0a6b36%7Cd67e5453732f4adc94a44888f2d97d5d%7C0%7C0%7C636355593482406340&sdata=aAMjb4W1R8WgnZ1q17Dcp0z2F5G%2BPO%2FZgXgrgxtJTW8%3D&reserved=0

https://na01.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.ecptote.state.tx.us&data=02%7C01%7CCandiceFreeman%40dcccd.edu%7C20c72343d57742e3892908d4ca0a6b36%7Cd67e5453732f4adc94a44888f2d97d5d%7C0%7C0%7C636355593482406340&sdata=Cd6KAVcOmhez9HWFn9rBlLf61Zk7uNBh5NjxexmDUhs%3D&reserved=0


your eligibility in order for your application to be considered. These letters must be received by the program by the application deadline.

IMMUNIZATIONS

Students will be required to submit required proof of current immunizations.

PERSONAL HEALTH INSURANCE

Students are required to carry personal health insurance and show proof of insurance prior to enrollment in the OTA program.

PROFESSIONAL LIABILITY INSURANCE

Students enrolled in the OTA Program are required to have professional liability insurance. Students will pay this fee with their lecture courses. NOTE: The liability insurance that each student will have does not pay for injuries to the student- only for injuries to the patient. The student is completely responsible for personal medical costs incurred while at fieldwork sites. If a patient is injured by the student, the limited liability insurance may or may not cover all legal costs.

CURRICULUM REQUIREMENTS

The Occupational Therapy Assistant program provides basic knowledge and skills for entry-level entrance into the workforce. Upon satisfactory completion of this curriculum, the student will be awarded an Associate of Applied Science degree and will be eligible to sit for the national certification examination administered by the National Board for Occupational Therapy (NBCOT) to become a certified occupational therapy assistant (COTA).

Courses in the OTA program must be taken in sequential order at the advisement of the program director and program faculty. Students may not “jump ahead” in the curriculum. A grade of “C” or better is required for satisfactory completion of all courses, including academic core courses.

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PROPOSED CURRICULUM

OCCUPATIONAL THERAPY ASSISTANT AAS

2018 (Fall 2018)

*All applicants must have a GED or High School diploma to apply LEC. LAB. EXT. CONT. CR.

SEMESTER I HRS. HRS. HRS. HRS. HRS.

**Prior to acceptance and enrollment into OTHA 1305 Principles of Occupational Therapy, the student must have completed 10 credit hours (ENGL 1301, PSYC 2301 and BIOL 2401) which would also apply to the Nursing AND degree:

PREREQUISITE SEMESTER

ENGL 1301 Composition 1 3 0 0 48 3

PSYC 2301 General Psychology 3 0 0 48 3

BIOL 2401 Anatomy and Physiology I 3 3 0 96 4

+ Elective Humanities/Fine Arts 3 0 0 48 3

Total semester hours: 12 3 0 240 13

SEMESTER I

BIOL 2402 Anatomy and Physiology II 3 3 0 96 4

PSYC 2314 Lifespan Growth and Development 3 0 0 48 3

OTHA 1305** Principles of Occupational Therapy 2 4 0 96 3

OTHA 1315 Therapeutic Use of Occupations and Activities I 2 4 0 96 3


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SEMESTER II

OTHA 2301 Pathophysiology in Occupational Therapy 2 2 0 64 3

OTHA 1319 Therapeutic Interventions I 2 4 0 96 3

OTHA 2209 Mental Health in Occupational Therapy 2 0 0 32 2

OTHA 2302 Therapeutic Use of Occupations and Activities II 2 4 0 96 3

OTHA 1161 Occupational Therapy Assistant Clinical-Adults 0 0 6 96 1

OTHA 1349 Occupational Performance in Adults 2 4 0 96 3


SEMESTER III

OTHA 1162 Occupational Therapy Assistant Clinical-Pedi 0 0 6 96 1

OTHA 1341 Occupational Performance in Pediatrics 2 4 0 96 3

OTHA 1163 Occupational Therapy Assistant Clinical-Elders 0 0 6 96 1

OTHA 1253 Occupational Therapy Performance in Elders 2 1 0 48 2

OTHA 2235 Health Care Mgt in Occupational Therapy 2 1 0 48 2

OTHA 2331 Physical Function in Occupational Therapy 2 4 0 96 3

OTHA 2305 Therapeutic Interventions II 2 4 0 96 3


SEMESTER IV

*OTHA 2266 Practicum for Occupational Therapy Assistant 0 0 20 320 2

*OTHA 2267 Practicum for Occupational Therapy Assistant* 0 0 20 320 2


=================

GRAND TOTAL: 2272 60

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Admission Process

Instructions for applying to the OTA Program

Admission to Mountain View College:

The following documents need to be on file for Mountain View College prior to application to the OTA program:

1. Apply for admission into Mountain View College athttps://www.mountainviewcollege.edu/apply-reg/Apply/Pages/default.aspx

2. Submit all official transcripts from colleges/universities other than Mountain ViewCollege to the Office of Enrollment Services at Mountain View College. If youhave any questions about transcripts please speak to Ms. Rebecca Soto at 214-860-8602 or email her at [email protected]

*All applicants must have a GED or High School diploma to apply

*All pre-requisites have to be completed prior to applying to the OTA program.

*Note: Anatomy & Physiology I with lab should be taken within the last five years as it isvital for you to grasp this material to be an OTA.

After completion of the application packet, you can bring your packet to the OTA Office in the W/ H building (Room W-29 suite).

During the month of April/May, application packets will be reviewed. Please refer to the “Admissions Rubric” where points are totaled for ranking. The highest total point applicant sets the bar for ranking. Applicants will be ranked in descending order based on point total. If two or more applicants tie for total points, core GPA will be used as a tiebreaker with the higher GPA ranked higher.

A maximum of twenty five applicants will be scheduled for a campus interview and on campus essay along with a possible entrance exam in the month of May. Applicants will be notified of acceptance no later than the end of June. At the time of notification, applicants will be given a 48 hour deadline of when they have to notify the program that they accept. Applicants who were placed on the waiting list will be notified in July if there are openings in the program.

All documents needed for the admission or included in this packet. Additional forms are available at https://www.mountainviewcollege.edu/cd/instruct-divisions/mvc/nursing/ota/pages/admissions.aspx

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https://www.mountainviewcollege.edu/apply-reg/Apply/Pages/default.aspx

https://www.mountainviewcollege.edu/cd/instruct-divisions/mvc/nursing/ota/pages/admissions.aspx

https://www.mountainviewcollege.edu/cd/instruct-divisions/mvc/nursing/ota/pages/admissions.aspx


*Place the above materials and your official transcripts in a 9" x 12" envelope for submission in person. The envelope must be received in the OTA Office (located ground floor in the W/H building) at Mountain View College by the deadline found on the application.

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Please type or print legibly in black ink. _________________________________________________________________________Social Security Number MVC ID # Texas Driver’s License# DL Exp. Date _________________________________________________________________________Last Name First Name MI _________________________________________________________________________ Mailing Address _________________________________________________________________________ City State Zip Code _________________________________________________________________________ Home Phone Cell Phone *Email Address *MANDATORY – Notifications will be made via email. Please ensure email address is correct and legible Date of Birth: ___/___/____ Age: _____ Gender: _____ Male _____ Female Ethnicity: ___American Indian/Alaskan Native ___Asian ___Black/African American ___Native Hawaiian/Pacific Islander ___Hispanic ___White ___Two or more races ___ Unknown Health Insurance: _____ Yes _____ No Name of Company: _________________________ Emergency Contact: _____________________________________________________________ Name Phone Do you have a High School Diploma or GED? (Circle One) Month/Year Awarded: _________ *All applicants must have a GED or High School diploma to apply Highest Degree Earned: _________________________ Month/Year: _____________________ Have you previously accepted or enrolled in another OT or OTA program? _____ Yes _____ No

APPLICATION DEADLINE: April 27, 2018

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If yes, please list the school(s) under prior education. Can we notify the schools?

_____ Yes _____ No

Prior Education (list most recent first)

GED Program, High School,

Colleges Attended

Location (City, State, Zip)

Graduation Date From/To

Hours Earned Date Degree Earned

1.

2.

3.

4.

*all applicants must have a GED or High School diploma to apply

Employment Record (list most recent or present position)

Company Name Date(s) Employed Position & Duties 1.

2.

3.

4.

Prerequisite Requirement Table

Course name and number

Semester & Year

Final Grade

School Where Course was taken

ENGL 1301 Composition I PSYC 2301 General Psychology

BIOL 2401 A&P I (Lecture/Lab)

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Elective Humanities/Fine Arts*(MUST be selected from the AAS Core options for Humanities/Fine Arts)

Observation Hours: Please fill out the following information AND submit the signed Hours of Observation Form. (8 hours in two different areas/settings).

Name of Facility Type of Setting Number of Hours 1. 2. 3.

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MOUNTAIN VIEW COLLEGE

Health Record

Date

Name: DOB: Last First Middle Month Day Year

Address: Street City & State Zip

Telephone: Home Work Cell or VM

Health Questionnaire: To be filled out by applicant.

I certify that I have:

1. Visual acuity, with or without corrective lenses. This includes but is not limited to the ability to complete a patient assessment, read small print, visualize and interpret monitors, and equipment calibrations. Yes No_ If no, Explain:

2. Hearing ability with or without auditory aids to understand the normal speaking voice without viewing the speaker’s face. This includes but is not limited to hearing monitor alarms, emergency signals, patient call bells, and stethoscope sounds originating from the patient’s blood vessels, heart, lungs, and abdomen. Yes No If no, Explain:

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3. Physical ability to stand for prolonged periods of time and a reasonable level of strength and endurance. This includes but is not limited to the ability to lift a minimum of 50 pounds, perform cardiopulmonary resuscitation, lift patients, move from room to room, maneuver in small spaces, and complete twelve hour shifts. Yes No If no, Explain:

4. Ability to communicate effectively orally, aurally, and in writing. This includes but is not limited to the ability to speak clearly and understandably to members of the health care team, patients, and families. The student must possess the ability to write legibly and professionally and use effective listening skills. Yes No If no, Explain:

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5. Manual dexterity, strength, and fine motor skills. This includes but is not limited to the ability toutilize sterile technique, prepare and administer medications, turn and move patients, and performother nursing procedures/skills. Yes No If no, Explain:

6. Reliable personal transportation and ability to attend all classroom and clinical experiences, both onand off campus. Yes No If no, Explain:

7. A normal level of health and immunity. This includes but is not limited to the ability to tolerateimmunizations and to work with a wide variety of potentially contagious patients. Yes No If no, Explain:

8. Ability to function safely and professionally under various stressful conditions.Yes No If no, Explain:

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9. Eligibility to meet The National Board of Certified Occupational Therapist & The Executive Council

of Physical Therapy and Occupational Therapy Examiners Licensure Requirements. This includes

but is not limited to passing a criminal background check and drug and alcohol screening. If drug

testing comes back with positive results that is an automatic dismissal from MVC OTA program

(Please be aware that some criminal history or psychiatric illnesses may preclude an individual

from licensure eligibility.) Yes No If no,

Explain:

Please answer the following questions:

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1. Are you currently pregnant? If yes, do you have any limitations that would prevent you from being

able to complete any of the tasks listed in the previous questions? Yes No If yes,

Explain:

2. Do you have any other conditions which might interfere with your ability to practice

occupational therapy? Yes No_ If yes, Explain:

3. List any prescription, over-the counter, or other medications or substances you have been using on

a regular or frequent basis during the past year (You may continue on a separate sheet ofpaper. Make sure your name and ID number are at the top of the page).

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With your OTA application packet, the following must be completed: Tuberculosis

Screening:

Submit documentation of testing with a physician’s or nurse’s signature or verification from the Health Facility.

Intradermal PPD (Mantoux) within six (6) months, unless previously positive.

Date Results _ __

_ _ _ _ Signature – Physician or Nurse

Chest x-ray- within one (1) year if PPD positive

Date Results _ _

_ _ _ Physician’s Signature

Updates of tuberculosis screening will be required every 12 months while enrolled in the Mountain View College nursing program.

Record of Required Immunizations

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List dates of immunizations or dates of lab results indicating seropositivity required. Each immunization requires a copy of the original record including the signature of the health professional who administered the immunizations and presentation of copies of all available immunization records.

Dates of Completed Series

Titer where appropriate

Copies of records presented to MVC nursing

Comments

1. Measles – 2 doses since

12 months of age if born prior to January 1, 1957, or verification of immunity.

2. Mumps – 1 dose since 12

months of age if born prior to January 1, 1957, or verification of immunity.

3. Rubella – 1 dose since 12

months of age or verification of immunity. Individuals born prior to January 1, 1957, are NOT exempt.

4. TDAP –1 dose within past

10 yrs.

5. Varicella—2 doses are

required. (If one dose was received prior to age 13, then only 1 dose is required. ) Confirmation of previous varicella disease signed by a physician, parent, or guardian may be accepted.

6. Hepatitis B vaccine series

must be completed before any clinical rotation or positive titer if series previously completed.

Rev. 1.27.16 5.


Initial dose:

One (1) month:

No student may begin clinical rotations without verification of

immunization status.

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PHYSICAL EXAMINATION: To be completed by physician, nurse practitioner or physician assistant.

NAME _ _ _ _ DATE SEX Last First Middle

HEIGHT _ WEIGHT TPR BP HEARING

VISION _ GLASSES CONTACT LENS: R _ L _

HISTORY: (Attach separate sheet if needed) Include any significant information regarding pertinent medical and surgical conditions and use of alcohol and/or drugs.

GENERAL APPEARANCE

Normal

Check each item in appropriate column

Abnormal

Describe every abnormality in detail (attach sheet if necessary)

Eyes-ears-nose-throat Mouth, teeth, neck

Heart and Vascular

Lungs

Abdomen and Viscera

Back, Vertebrae

Extremities

Skin

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Neurologic

Laboratory and Diagnostic Data: (May attach copy.) Appropriate lab findings for this student:

Name of Test Results_ _ _ Health Care Provider Signature _________________________Date__________________

Physical exam form will not be accepted without health provider signature or verification for each immunization and TB screening

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Laboratory and Diagnostic Data: May attach copy.) Appropriate lab findings for this student: Name of Test Results

I believe this applicant is physically, mentally and emotionally healthy enough to participate in an occupational therapy assistant education program. I am aware that this program includes care of patients who are hospitalized. I also believe that the student has the ability to lift or carry objects that weight up to 50 pounds.

_

_ _

Health Care Provider Signature _ Date

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OTA Application for Admission 10

Physical exam form will not be accepted without either the provider signature stamp or on attached letterhead from the provider confirming the validity of the information indicated on the physical examination from.



Mountain View College Associate Degree OTA Program

Checklist for OTA Applicants

Date:__________________ Name:_________________________ Id# _____

Phone Number Email address This tool has been provided for you as a quick checklist to ensure you provide all documentation in the application process. Have you enclosed or submitted in application packet:

Completed a Dallas Community College District (DCCCD) application for college admission? Completed the Texas Success Initiative requirements? Submitted 3 recommendation forms in signed and sealed envelopes with my packet.

Submitted all observation feedback forms with signatures. (40 hours at two different areas of practice) Completed a GED or High School Diploma? Completed the four OTA prerequisite courses with a cumulative GPA of 2.75 or higher and a “C” or better in each course? Submitted Official Transcripts from all colleges/universities attended to the Admissions Office by the deadline? (Also in packet)

Prepared and dated an OTA Program Application? Texas Driver’s License Social Security Card Proof of Medical Insurance Proof of Background check (Group One receipt)

Health Record/Documentation of Immunizations Records, Physical Examination, CPR (Health Provider) Other: TB skin Test or Chest X Ray submitted once accepted into the program (Review Admission Time line) ____ Place the above materials and your official transcripts in a 9" x 12" envelope for submission either in person. The envelope must be received in the OTA Office (Office: W-29) at Mountain View College by the deadline found on the application.

I am applying for the OTA Program and have submitted my application to the OTA Office. I understand that this is not an acceptance into the program; this is the beginning of the application process. I have reviewed my application and to the best of my knowledge have determined that all requirements have been met and submitted in a timely manner.

Signature

Date



This application will be used in the accumulation of points for the admission process. Students admitted are aware that Mountain View College is in Candidacy status per ACOTE and not yet accredited. Final decisions on point allocation will be determined by the program director.

I hereby certify that the information in this application is true and complete to the best of my knowledge. I understand that any misrepresentation or falsification is cause for denial of admission or expulsion from the college. I understand that the faculty and staff of Mountain View College- Occupational Therapy Assistant Program will read the information contained in this application.

____________________________________ ________________________

Signature of Applicant Date

Please submit requested information only. Other documents submitted other than those requested will not be considered.



Appendices

A. Admission Worksheet Rubric B. Occupational Therapy Assistant Observation Feedback Form C. Letter of Recommendation Form (turn in 3 recommendation forms)



Appendix A

Comments:___________________________________________________________________________________________________________________________________________________________________

Note the following:

• Proof of employment required for points to be given for related healthcare work experience. Please include in application packet.

• After careful tabulation of the applicant’s accumulated points (essay included), experience, and character (interview), the program director will make the final decision for acceptance for all OTA applicants.

Student Name: ID#: Application Semester:

Grade Hours Grade Points Term Repeat ENGL 1301 Composition I 3 12 9 6 3 0 Y / N PSYC 2301 General Psychology 3 12 9 6 3 0 Y / N BIOL 2401 A&P I (Lecture/lab) 4 16 9 6 3 0 Y / N Elective Humanities/Fine Arts*(Must be selected from the AAS Core options for Humanities/Fine Arts)

3 12 9 6 3 0 Y / N

Subtract 1 point for each repeated course due to a D or F. Pts. Subtracted: Total

Hrs.:

/13 Total GP: Grade Pts. Total:

A= 12 pts (16 pts for BIOL) B= 9 pts C=6 pts D= 3 pts F=0 pts Points Overall GPA: Min. 2.75 required Total Grade Points/Total Hours = GPA:

2.00 - 2.50 = 1 2.51 - 3.00 = 4 3.01 – 3.50 = 7 3.51 – 4.00 = 10 Observation Hours Max Possible 10 Points; 5 points if completed in only 1 area of practice Completed 40 hours of observation (from at least 2 different areas of practice) Letters of Recommendation 5=120-115 4=114-104 3=104 and below Three letters of Recommendation will be added together for total points. Optional Degree (s) or Certificate Program(s): Max Possible Points up to 5 (only credit for 2) Bachelor’s Degree = 3 points Associate’s Degree = 2 points Certificate Program (Pharmacy Tech, Medical Assisting, Surgical Tech, Vocational Nursing, etc.) = 2 points Related Healthcare Work Experiences: <6 month = 3 6-12 month = 4 >12 month = 5 Rehab Tech/CNA/Aide/Worked in an Allied Health Field (PTA, Biologist, etc.) Completed Transcript Evaluation Max Possible Points 2

(Max points 45) Pre-interview Point Total

Essay Max Possible Points 25 Interview Max Possible Points 30 Total Points Max Possible Points 100



Appendix B

Observation/Volunteer Record Occupational Therapy Assistant Program

Submit one form for each facility in which observation/volunteer hours were completed.

Applicant Name (PRINT):________________________________________________________

This applicant has observed/volunteered _______ hours under my supervision.

Name and Credentials: ___________________________________________________________

License # _______________________________ State: _________________________________

Facility Name: _________________________________________________________________

Address: ______________________________________________________________________

Phone Number: (____) _________________ Email: ___________________________________

Superior (5) Good (4) Average (3) Below Average (2)

Poor (1)

Arrived on Time

Appropriately Dressed

Interaction with Staff

Interaction with clients/patients

Overall impressions of likely success as an OTA in a setting such as yours:

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

By signing this form, I certify that the above applicant completed the stated hours.

Signature and Date: _____________________________________________________________



Appendix C

Letter of Recommendation Occupational Therapy Assistant Program

Applicant’s Name: ______________________________________________________________ In requesting the completion of this evaluation form which will be used in the admission selection process for the occupational therapy assistant program at Mountain View College, I waive my right to access to the document. _______________________________ (Applicant Signature) Name of individual completing form: _______________________________________________

Phone #: ______________________________ Email: _____________________________

If OT/OTA License #: ___________________ State: ______________________________ *Note to individual completing form: Recommendations account for 20% in determining admission into the occupational therapy program. Please complete accurately and honestly and return to applicant in a sealed envelope. Thank you for assisting in the admission process of the above applicant. Rating Scale:

Superior Above Average Average Below Average Poor 5 4 3 2 1

Evaluation Area Rating

Attitude and Personality: Mannerisms, disposition, ability to work with people, confidence, acceptance of criticism.

Reliability and Character: Dependability, integrity, honesty, trustworthiness.

Personal Appearance: Cleanliness, grooming.

Work Habits and Industry: Conscientiousness, following through, resourcefulness, self-discipline, initiative, willingness.

Composure: Reaction to stress, poise, self-control, adaptability.

Capacity for Independent Thinking: Leadership ability, creative thought, curiosity, demonstrates interest.

Judgment and Common Sense: Ability and foresight in everyday decisions, expression of opinion, maturity.

Oral Expression: Clarity, coherence, and confidence in conversation.

Overall Impression of this applicant: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________



CONTACT INFORMATON Dr. Candice Freeman OTD, MOT, OTR/L Program Director- Mountain View College Occupational Therapy Assistant Program 4849 W. Illinois Ave. Dallas, TX 75211 Office: W-29 suite Phone: 214-860-3605 (main office number) Fax: 214-860-8880 (call before faxing) Program website: http://mountainviewcollege.edu/ota

http://mountainviewcollege.edu/ota

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