School of Health Sciences
Occupational Therapy Assistant Program
OTA PROGRAM APPLICATION PACKET
Dear Prospective Occupational Therapy Assistant Student:
Thank you for your interest in the future Occupational Therapy Assistant (OTA) Program at Hawkeye Community College. The need for skilled, practice-ready occupational therapy assistants continues to grow. OTAs can look forward to dynamic careers working in multiple settings with people of all ages, fostering their independence to participate in life to its fullest.
The OTA Program at Hawkeye Community College has been designed to offer stimulating and rigorous classroom and clinical experiences for all students, from young adults pursuing their first career to adults who have been out of school for some time or those who are changing careers.
The Occupational Therapy Assistant program at Hawkeye Community College has been granted accreditation by the Accreditation Council for Occupational Therapy Education (ACOTE) of the American Occupational Therapy Association (AOTA).
Graduates will be eligible to sit for the national certification examination for the occupational therapy assistant administered by the National Board for Certification in Occupational Therapy (NBCOT) once all didactic and fieldwork requirements are completed with passing grades.
American Occupational Therapy Association, Inc. National Board for Certification in 4270 Montgomery Lane, Suite 200 Occupational Therapy
P.O. Box 31220 800 S. Frederick Avenue, Suite 200
Bethesda, MD 20824-1220 Gaithersburg, MD 20877-4150
301-652-6611 x2914 301-990-7979
accred@aota.org www.nbcot.org
We are glad that you have considered Hawkeye Community College for your OTA education. The application packet includes all the information you will need to apply to the program. Please feel free to contact us for further information in regard to the OTA program.
Sincerely,
Cindy Koehn Cindy Koehn, OTR/L
OTA Fieldwork Coordination/Faculty cindy.koehn@hawkeyecollege.edu
Occupational Therapy Assistant Program
Application Process1. Apply for admission to Hawkeye Community College (HCC). The HCC application for admission should be completed online at https://www.hawkeyecollege.edu/apply-for/admission/default.aspx . This
information can also be accessed from the ADMISSIONS tab on the top of the HCC website homepage. A
letter of acceptance or non-acceptance will be sent by email you of your status once you have completed the application. If you are not accepted into the new cohort, you must resubmit the application form to keep your file active which includes your observation hours and update the immunization and physical documents. Failure to do so will result in being removed from the candidate list. The application must be resubmitted on an annual basis. This is due by December 1.
2. Arrange for official transcripts (high school transcripts, GED, and any college transcripts) to be sent to the HCC Admissions Office at the following address:
Hawkeye Community College Admissions Office
1501 East Orange Road P.O. Box 8015
Waterloo, IA 50704-8015
3. The Occupational Therapy Assistant (OTA) program is a 1+1 model. Phase I consists of the general education foundational content components of the program. Phase II is the professional or “core”
component. Admission to the OTA program is dependent upon successful completion the following Phase I courses with a minimum GPA of 2.75:
BIO 168 Human Anatomy and Physiology I w/lab* HSC 113 Medical Terminology
ENG 105 Composition I
PSY 111 Introduction to Psychology MAT 101 Math for Liberal Arts CSC 110 Introduction to Computers
BIO 173 Human Anatomy and Physiology II w/lab* SPC 101 Fundamentals in Oral Communication HSC 108 Introduction to Health Professions PSY 121 Developmental Psychology
PSY 241 Abnormal Psychology
SOC 110 Introduction to Sociology OR SOC 205 Diversity in America
Students may apply for admission to the OTA program while in the process of completing the Phase I courses. *Students must have a grade of B or higher.
Applying to the OTA Program
1. Application is Due by December 1
2. OTA program application packets are available online. The application packets will be processed when a completed packet has been turned into the OTA office.
3. Obtain an OTA application packet. The packet can be acquired in the following ways: A. Download from - www.hawkeyecollege.edu/occupationaltherapy .
B. Stop by the OTA program office.
4. Applicants will be required to submit credentials (transcripts and test scores) as required by the program’s admission requirements.
5. Complete and submit required forms: A. Student Application
B. A copy of college diplomas, if applicable C. A copy of your transcripts
D. Curriculum Checklist – fill out the checklist by identifying the course you have taken and the grade you received in each course. If you will be taking any of the prerequisite courses during the summer, please list the course section you will be attending. If you are taking summer courses at a location other than HCC, have official transcripts resubmitted once that grade is posted.
E. Observation Form - Provide documented evidence of 8 hours of observation time with a licensed occupational therapist or certified occupational therapy assistant at 3 different facilities, for a total of 24 hours. Observations must include at least two different types of facilities (example: outpatient, inpatient, home health, long-term care).
F. Immunization Form from your doctor office G. Student Health and Immunization Record
H. Iowa Core Performance Standards Acknowledgement I. Completed resume.
6. Schedule a meeting with the Program Director or Academic Fieldwork Coordinator. 7. Completed applicant files will be processed as follows:
A. Applicants who do not meet the program’s admission requirements will be inactivated. A new application will need to be completed.
B. Applicants enrolled in coursework to complete the admissions requirements will be candidates. C. Applicants who meet the OTA program’s admission requirements will be accepted for admission into
phase II of the program however if the number of accepted applicants is over 20, the student will be placed on a waiting list. No exceptions will be made.
D. Applicants who meet the OTA program’s admission criteria will receive an email notifying them of acceptance or conditional acceptance into the program.
E. Applicants must complete all conditional acceptance criteria or they will not be a candidate for the upcoming summer cohort.
8. The program will accept up to 20 students for each summer to begin Phase II.
9. Upon being offered acceptance to begin the phase II of the OTA program, if the applicant chooses to decline their acceptance, their file is inactivated and they will need to re-apply for the program when interested.
10.Students must achieve a minimum “C” grade in all courses required to continue and to complete the Phase II portion of the OTA program.
11.Students who are not accepted into the summer phase II cohort, must submit a new application form (see the following page) to be reconsidered for the acceptance into the next cohort by December 1. This allows the program to have the most recent information on file and that you are still interested in the phase II of the OTA program. You will not have to resubmit a new observation form.
*
Changes are taking place within healthcare facilities nationally. These changes directly affect all health programs at Hawkeye Community College. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which accredits healthcare facilities across the country, enforced background screening September 2004 and has set requirements mandating that students in a healthcare field must now complete the same background check as hospital employees. As a Health student of Hawkeye Community College you will be required to complete a criminal background check, Medicare/Medicaid fraud, sex offender, urinalysis, child abuse and dependent adult registry. The outcome could possibly affect your opportunities to participate in the clinical setting.Hawkeye Community College does not discriminate on the basis of sex, race, age, color, creed, national origin, religion, disability, sexual orientation, gender identity, or genetic information in its educational programs, activities, admission procedures, or employment practices. Students, prospective students, employees, or
applicants for employment alleging a violation of equity regulations shall have the right to file a formal complaint. Inquiries concerning application of this statement should be addressed to: Equity Coordinator, Human Resource Services, Hawkeye Community College, 1501 East Orange Road, P.O. Box 8015, Waterloo, Iowa 50704-8015, telephone 319-296-4405.
Occupational Therapy Assistant Program Application
* Required information. This form may be filled out on the computer or use of black pen and information must be printed clearly. Personal Information
*
Name: (First) (M.I.) (Last) ________________________*List any degrees you have completed to this date:
Name(s) that appear on previous educational records if different from above.
Name: (First) (M.I.) (Last) _______________________
*Mailing Address: Street PO Box or Apt #
City Zip Code: Is this your permanent address? Yes No (if no please supply your permanent address below)
*Mailing Address: Street PO Box or Apt #
City Zip Code:
*Primary Phone: ( ) Alternate Phone: ( ) _________________
*Home E-mail: _____ _____
*Hawkeye E-mail:
If your contact information changes, please notify the program office immediately.
*Semester you desire to start Phase 2 of the OTA program: Fall of (year) ________
Submission of this application signifies that you have completed the prerequisites and the appropriate records are on file with the Hawkeye Community College (HCC) Admission Office: high school and/or college transcripts and a HCC application. The program will verify that the prerequisites have been met. With the exception of the completion of general education courses, any
prerequisite found to be incomplete will cause the application to be returned to you. Your file completion date will be the date a completed admissions packet, including required forms, is received by the program office (all prerequisites met).
The file completion date is used to determine entry to the program if there are more than 20 students who have completed all the criteria (prerequisites and observations). Once a class of 20 is filled, a waiting list will be maintained based on the file completion
date. Students are encouraged to complete the program application process early. Final acceptance into Phase 2 will depend upon
the successful completion of the Phase 1 course work and passing the required background checks.
Upon acceptance to Phase 2 of the OTA program, the student will complete the Criminal Background check waiver for Occupational Therapy Assistant students. This form can be found in the OTA Student Handbook students receive following acceptance into the program.
Student Signature:_____________ ____________________ Date:
Occupational Therapy Assistant Program – Curriculum Checklist for Program Prerequisites
Name:____________________________
_
HCC Student ID:_______________________
FIRST YEAR - SEMESTER I
CREDITS LETTER GRADE GRADE OF COURSES TRANSFERRED GRADE POINTS BIO 168 Human Anatomy and Physiology I w/Lab* 4 CSC 110 Introduction to Computers 3 ENG 105 Composition I 3 HSC 113 Medical Terminology for Health Sciences 2
MAT 110 Math for
Liberal Arts 3 PSY 111 Introduction to Psychology 3 Total 18
FIRST YEAR – SEMESTER II CREDITS LETTER GRADE GRADE OF COURSES TRANSFERRED
GRADE POINTS BIO 173 Human Anatomy
and Physiology II w/Lab *
4 HSC 113 Introduction to Health Professions 2 PSY 121 Developmental Psych 3 PSY 241 Abnormal Psychology 3 SOC 110 Introduction to Sociology or SOC 205Diversity in America 3 SPC 101 Fundamentals of Oral Communication 3 Total 18
Students need to have a “B” or higher grade to process application.
Students may complete Phase I course work any time prior to entering Phase II, with the exception of
Human Anatomy and Physiology, which must be taken within five years of entry into Phase II, unless
waved by the program director. Transfer students must have an official copy of their transcripts sent to
the Admissions Office for approval of general education courses.
The minimum cumulative GPA for Phase I courses is 2.75. Students must receive a grade of at least 2.0
(“C”) or better on a 4.0 scale for all Phase I courses, with the exception of BIO 168Human Anatomy and
Occupational Therapy Assistant Program
Hawkeye Community College
Pre-admission Observation Hours
Student Name (printed): ________________________________________________________
The individual who has asked to observe at your facility is interested in applying to the OTA program at
Hawkeye Community College. This observation is part of the admission requirements. Through this
experience, we anticipate that the applicant will gain first hand exposure to occupational therapy in order to
determine a correct career choice. We ask that they observe a registered occupational therapist (OTR) or
certified occupational therapy assistant (COTA) for 8 hours of direct patient care in 3 different clinical settings
(example: outpatient, inpatient, home health, long-term care, etc.). Observations must include at least two
different facilities. The 8-
hour observation can be completed in one or more visits, depending on your facility’s
preference. Observations will not be accepted from your current employer. Please complete the information
below to document that the student has completed the observation requirement. Thank you for your
assistance with this process. If you have any questions or concerns please feel free to contact the
Occupational Therapy Assistant Program Director or Academic Fieldwork Coordinator.
*Students are responsible to arrange observation hours and adhere to all facility
professional dress code, policies and procedures.
*Completed observation forms and observation log must to be returned to the Occupational Therapy
Assistant program with a student’s completed application packet and current resume.
**Your supervisor has the right to send you home
or refuse the observation, if you are not properly
dressed, demonstrating unaccepted professional
behavior, etc.
Observation 1:
Facility Name: __________________________________ City: __________________________
Facility Type: Acute IP OP Clinic Home Health Nursing Home Rehab Center Other: ____________
Date
Time
Facility
Signature of Supervisor
I verify that I am a registered occupational therapist or certified occupational therapy assistant and the above
named individual observed with me for a total of 8-hours.
Clinician Name: ___________________________________
License #_______________
Clinician Signature: _________________________________
Date: __________________
Observation 2:
Facility Name: __________________________________ City: __________________________
Facility Type: Acute IP OP Clinic Home Health Nursing Home Rehab Center Other: ____________
Date
Time
Facility
Signature of Supervisor
I verify that I am a registered occupational therapist or certified occupational therapy assistant and the above
named individual observed with me for a total of 8-hours.
Clinician Name: ___________________________________
License #_______________
Clinician Signature: _________________________________
Date: __________________
Observation 3:
Facility Name: __________________________________ City: __________________________
Facility Type: Acute IP OP Clinic Home Health Nursing Home Rehab Center Other: ____________
Date
Time
Facility
Signature of Supervisor
I verify that I am a registered occupational therapist or certified occupational therapy assistant and the above
named individual observed with me for a total of 8-hours.
Clinician Name: ___________________________________
License #_______________
Clinician Signature: _________________________________
Date: __________________
My signature certifies that the above information is accurate. Hours listed with current employer will not be
accepted and need to observe in a minimum of 2 different settings. I understand that if I have falsified the
information, I will be denied eligibility to continue the application process of the OTA Program. The hours
must be equivalent to a total of 24 hours.
_________________________________________________
__________________
Iowa Core Performance Standards for Health Care Career Programs:
Iowa Community Colleges have developed the following Core Performance Standards for all applicants to Health Care Career Programs. These standards are based upon required abilities that are compatible with effective performance in healthcare careers. Applicants unable to meet the Core Performance Standards are responsible for discussing the possibility of reasonable accommodations with Hawkeye Community College Students Disability Services Office. Before final admission into a health career program, applicants are responsible for providing medical and other
documentation related to any disability and the appropriate accommodations needed to meet the Core Performance Standards. The student must meet with the Students Disability Services Office to complete the process for the necessary accommodations.
Capability Standard Some Examples of Necessary Activities (not all inclusive) Cognitive-Perception The ability to perceive events
realistically, to think clearly and rationally, and to function appropriately in routine and stressful situations.
• Identify changes in patient/client health status • Handle multiple priorities in stressful situations
Critical Thinking
Critical thinking ability sufficient for sound clinical judgment.
• Identify cause/effect relationships in clinical situations
• Develop plans of care
Interpersonal Interpersonal abilities sufficient to interact appropriately with
individuals, families, and groups from a variety of social, emotional, cultural and intellectual
backgrounds.
• Establish rapport with patients/clients and colleagues
• Demonstrate high degree of patience
• Manage a variety of patient/client expressions (anger, fear, hostility) in a calm manner
Communication Communication abilities in English sufficient for appropriate
interaction with others in verbal and written form.
• Read, understand, write, and speak English competently
• Explain treatment procedures • Initiate health teaching
• Document patient/client responses • Validate responses/messages with others
Mobility Ambulatory capability to sufficiently maintain a center of gravity when met with an opposing force as in lifting, supporting, and/or transferring a patient/client.
• The ability to propel wheelchairs, stretchers, etc., alone or with assistance as available
Hearing Auditory ability sufficient to monitor and assess, or document health needs.
• Hears monitor alarms, emergency signals, ausculatory sounds, cries for help
• Hears telephone interactions/directions
Visual Visual ability sufficient for observation and assessment necessary in patient/client care, accurate color discrimination.
• Observes patient/client responses • Discriminates color changes
• Accurately reads measurement on patient/client related equipment
Tactile Tactile ability sufficient for physical assessment, inclusive of size, shape, temperature, and texture.
• Performs palpation
• Performs functions of physical examination and/or those related to therapeutic intervention, e.g. insertion of a catheter
Activity Tolerance
The ability to tolerate lengthy periods of physical activity.
• Move quickly and/or continuously
• Tolerate long periods of standing and/or sitting
Environmental Ability to tolerate environmental stressors.
• Adapt to rotating shifts
• Work with chemicals and detergents • Tolerate exposure to fumes and odors • Work in areas that are close and crowded • Work in areas of potential physical violence
Occupational Therapy Assistant Application
Iowa Core Performance Standards for Health Care Career Programs
Acknowledgement Form
Please sign and return this portion of the document with the other required application
packet forms.
My signature acknowledges that I have been provided with the document “Iowa Core Performance
Standards for Health Care Career Programs” and am familiar with its content. I understand that I may
request reasonable accommodations in order to meet these standards.
Name (please print):_______________________________________________________________________
*Please make a copies of the original completed
physical and immunization forms. Clinical sites
may request a copy of this information and it is
your responsibility to provide those copies. The
program will not provide copies of your physical
and immunization record.
Fall 2015
STUDENT HEALTH AND
IMMUNIZATION RECORD
Health Science Programs
______________________________________
(Please Put Program Name Here)
______________________________________
(PLEASE PRINT YOUR NAME HERE)
Fall 2015 Hawkeye Community College Health Science Medical History
Name_______________________ Student ID______________ Program______________________ Address_________________________________________ Telephone_____________________________ Emergency Notification__________________________________
Address_______________________________________________ Telephone___________________________________ __________________________________________________________________________________________________
MEDICAL HISTORY
Prior to your exam, please answer all questions. Comment on all “yes” answers, including year of occurrence.
Have you had/or currently have? Y N Comments
Heart Disease (High Blood Pressure) Diabetes
Respiratory Disorder (Asthma, TB)
Ear, Nose Throat Problems (Assistive Hearing Device) Psychological or Emotional Disorder
Convulsive/Seizure Disorder Hepatitis, Liver Disease Disease or Injury of Joints Back Problems
Has your physical activity been restricted during the past 5 years? (Give reason/duration)
Do you have any physical limitations that restrict activity and/or require special adaptation(s)?
Have you had any serious illness or injury, or been hospitalized other than already noted? Give details. Do you have or are you a carrier of any Infectious disease which pose a health or safety risk to you or others? (If yes, explain and provide statement from healthcare provider under which conditions you can’t participate)
Do you have any condition that would restrict activity and/or require special adaptation(s)?
Are you currently being treated by a health care professional for any condition(s)?
Are you taking any medications regularly or as needed (other than aspirin/ibuprofen/Tylenol)
Allergies/sensitivities (latex, medications, environmental, food)
If there is a change in this information, I will notify my instructor.
HAWKEYE COMMUNITY COLLEGE PHYSICAL EXAM
Student Name: _____________________ Student ID__________ Program_______________________ To be completed by a physician, nurse practitioner, or physician assistant.
Clinical Evaluation WNL
(within normal limits) Comments Eyes
Ear, Nose, Throat Mouth, Teeth, Gums Hearing and Visual Acuity Neck/Thyroid (ROM) Lungs/Chest
Heart (Rhythm, Rate, Murmur)
Abdomen
Back/Spine (ROM,
tenderness) Lifting Restriction? �Yes or �No Straight Leg Raise
Neurologic Other findings
If health conditions are present, do they create a limitation in the ability to provide health care? �Yes or �No Explain: __________________________________________________________________________________________
Does your examination reveal any active illness that would be a hazard to others? �Yes or �No
Explain: __________________________________________________________________________________________ Based on today’s exam and the disclosed health history, this student does not have any health condition that would create a hazard to self and others, or limit their ability to provide health care. In addition, this person is capable of performing the physical requirements of his/her program which can include bending, stooping, pushing and lifting without weight
restriction.
Agency or Clinic Name
Printed Name Title
Signature Date of exam
HAWKEYE COMMUNITY COLLEGE IMMUNIZATION RECORD Name___________________________ Student ID_______________ Program______________________________
Immunization requirements: In order for this form to be accepted EACH vaccination that is
documented must have a provider’s signature or stamp of provider Vaccine Date of
Administration
Signature or Stamp of Provider for each vaccine:
*Hep B #1
Required before clinical experiences
*Hep B #2 *Hep B #3 Measles #1 Measles #2
Not required if born prior to 1957
Mumps #1 Mumps #2
Not required if born prior to 1957
Rubella #1
Td-One booster in last 10 years Tdap- One time dose required i n l a s t 1 0 y e a r s regardless of the interval between the last Td/Tetanus.
Td/Tetanus only is not sufficient
Varicella #1
if no documentation of chickenpox disease
Varicella #2
if no documentation of chickenpox disease
Verification date of Varicella. If date cannot be confirmed by year-a titer must be dryear-awn
Date:
Titer Positive_______ Titer Negative______
Seasonal Influenza
PROOF OF TB TESTING The following are also required:
Initial 2-Step Mantoux (TB) test (Two separate TB tests placed 7-30 days apart and read within 48-72 hours after each TB test). Test Date Placed RT or LT arm Date Read Signature of Provider: *Invalid without signature*
Results Positive Or Negative 2-Step: Test #1 mm 2-Step: Test #2 mm Annual Test:
1step TB test only required after initial 2 step TB test was performed
-or-
Annual Chest x-ray is performed -or-
Annual Gold blood test is performed
mm
Results Neg._______ Pos.________
