OCCUPATIONAL THERAPY ASSISTANT PROGRAM APPLICATION GUIDE AND CHECK LIST

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OCCUPATIONAL THERAPY ASSISTANT PROGRAM

APPLICATION GUIDE AND CHECK LIST

To: Applicants of the Crowder College Occupational Therapy Assistant Program From: Debra Kennedy

Allied Health Programs Division Chair Date: April 15, 2015

RE: OTA Program Application Materials

Thank you for your interest in the Crowder College Occupational Therapy Assistant Program. If you have any questions, please don’t hesitate to call our office at 417-673-2437 or email [email protected].

Applications are due by August 1st_{, 2015 to be considered for acceptance.}

If you are not already enrolled at Crowder College, you will need to apply for admission and request that all transcripts from other colleges you attended be sent to Crowder College.

● Complete a minimum of 12 hours volunteer work or in observation with Occupational Therapy/Occupational Therapy Assistant. Included in the application packet is a Volunteer/Observation Form which must be signed by the supervising Occupational Therapist/Occupational Therapy Assistant.

You must complete the following course requirements prior to beginning the OTA program:

● ENGL 101 English Composition 3 credit hours ● PSYC 101 General Psychology 3 credit hours ● BIOL 152 Anatomy & Physiology I 5 credit hours ● SPCH 101 Fundamentals of Speech 3 credit hours

● COLL 101 College Orientation 1 credit hour (may not apply to returning students or those transferring in 12 or more credit hours)

NOTE: OTA core courses must be completed at Crowder College and will not be substituted by courses taken at other institutions and/or from work experience.

Allied Health Division

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APPLICATION CHECKLIST

**Only completed application packets will be considered for acceptance into the OTA program.**

The application packet and application fee is due on or before August 1st_{, 2015.}

Application packets received after August 1st will not be considered.

Please ensure all items listed below are completed with your application process:

________ Apply and be accepted for admission to Crowder College, a one-time application fee is required. (Application may be completed at any Crowder College campus or Online at Crowder.edu). ________ Completed and signed OTA application for admission

________ $40.00 non-refundable OTA application fee (make check or money orders payable to Crowder OTA. This is a separate fee from the Crowder College application fee for admission).

________ Unofficial Transcripts

________ Signed Criminal History Records Disclosure Consent form ________ Complete and sign Request for Criminal Record Check

________ Signed Missouri State Highway Patrol MoVECHS Waiver Agreement and Statement form

________ Signed Limited Waiver of Confidentiality ________ Completed Personal Essay

________ Completed Volunteer/Observation Forms

________ Reference Forms completed by three individuals

Please mail application with all required documents, and $40.00 fee in a manila envelope to:

Crowder College Allied Health Department

Occupational Therapy Assistant Program

600 S. Ellis

Webb City, MO 64870

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PROGRAM ACCEPTANCE GUIDELINES

Applicants will be selected for admission based on the following criteria:



Applicant must be approved for admission to the college



Applicant must have a high school diploma or G.E.D. certificate



Completion of Pre-Admission requirements by the time OTA courses begin

A cumulative score based on the following criteria:

 Grade Point Average

 Observation Experience

 Personal Essay

 College Degree

 Certificate/License

 Crowder College Student

 Previous Application

 References

 Interview

Grade Point Average:

Applicants will be evaluated based on grades earned in the prerequisite courses and all other courses the student intends to transfer to fulfill the OTA program requirements. A minimum GPA of 2.75 is required to apply to the program. Applicant must achieve a grade of “C” or better in the pre-admission required courses.

Observation Experience:

A minimum of 12 hours of observation experience in Occupational Therapy (OT) is required. Observation hours must be in:

1. At least two different treatment settings 2. At least 6 hours in each setting.

The hours must be documented on the Volunteer/Observation Form included in the application packet by a registered and licensed Occupational Therapist (OTR/L) and/or licensed and certified Occupational Therapist Assistant (COTA/L) with one or more years of experience. You will be awarded points based on the score provided by the OT/OTA.

In addition to the minimum 12 hours, the following will be considered:

 Volunteer/Observation hours over the required 12 hours

 Volunteer/Observation hours in more than the two required treatment settings must be at least 2 hours.

Personal Essay:

Applicants must submit a short essay. The essay must be at least one page long but not exceed two pages in length. Essay should be typed in Times New Roman 12 point font and be double-spaced utilizing correct grammar and spelling.

The essay must address the following questions:

1) Why do you want to pursue a career as an Occupational Therapy Assistant?

2) What is your personal experience with Occupational Therapy?

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College Degree:

Any previously completed college degree will be considered in the cumulative score. Certificate/License:

Any previously completed healthcare certificate or license will be considered in the cumulative score.

Crowder College Student:

Previously completed courses at Crowder College will receive consideration in the cumulative score.

Previous Application:

Previous application to the Crowder College OTA program will receive consideration in the cumulative score.

Reference Forms:

Each applicant will need to ask three (3) different individuals to fill out a personal Reference Form (included in this packet). These individuals should not be related to the applicant but has knowledge of the applicant’s character, such as a co-worker, instructor or supervisor.

The Reference Form must be filled out by the individual chosen as a personal reference. The Reference Form must be placed in an envelope, sealed and signed across the seal with the applicant’s name. The Reference Form may be turned in with the application packet or mailed directly to the Allied Health Department.

Interview:

Written applications will be scored and you may be selected to come in for an interview by a panel of instructors and professionals. Interviews will be scored and added to the cumulative score.

**Only completed application packets will be considered for acceptance into the OTA program**

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APPLICATION FOR ADMISSION

Name:____________________________________________________________________________________________________

(last) (first) (middle) (maiden)

Address:______________________________________City:__________________State:_______Zip:______________________ Social Security #:_________________________________Telephone Number:_________________________________________ Telephone Number to leave message if unable to reach at above number: ___________________________________________ E-Mail address: ___________________________________________________________________________________________ I. Education: List high school or GED and all college (including classes currently in):

Name of School Address From To Degree or Hours Earned

____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ II. Occupational Experience-list all employment within the past 5 years:

Employer Address Type of Work From To

____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ List the names of the three individuals you have given reference forms to on your behalf:

1.___________________________________________ _____included with application ______being mailed 2.___________________________________________ _____included with application ______being mailed 3.___________________________________________ _____included with application ______being mailed III. Have you previously applied to the Crowder College Occupational Therapy Program?_ ___Yes_____No

IV. Do you have any certifications or licensures in the medical field? _____________ Yes ______________No If yes, what is it for?___________ Please attach a copy of certificate or license when submitting application. V. Yes, I have_____(OR)_____ No, I have not been convicted of or plead guilty to a crime. If yes, describe the crime(s)

and the particulars:____________________________________________________________________________________

If you have been convicted of a misdemeanor of 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 and Occupational Therapy

Examiners at 512-305-6900, www.ecptote.state.tx.us to determine your certification and licensure eligibility.

___ I do hereby certify that the above information is complete and correct to the best of my knowledge, under penalty of perjury.

___ I understand that any question answered in a false manner will result in the application being void, and therefore, not considered.

___ I understand that as an occupational therapy assistant student I am required to have access to a computer with internet, Microsoft Office 2010, and printer. Access to this is available at all of our Crowder College campuses Monday through Friday from 8:00 a.m. to 5:00 p.m. It is HIGHLY recommended that you have access to high-speed internet, Microsoft Office 2010, and printer at home.

I understand that I will not be considered for admission into the Occupational Therapy Assistant program until I have completed the application process as outlined in the application information sheet.

______________________________________ ____________________________________

Signature (written) Name (printed)

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CRIMINAL HISTORY RECORDS DISCLOSURE CONSENT

CROWDER COLLEGE

OCCUPATIONAL THERAPY ASSISTANT PROGRAM

As a requirement of the Crowder College Occupational Therapy Assistant Program application process, in response to the House Bill 1362, I consent to the release of my criminal history records to the Crowder College Occupational Therapy Assistant Program.

The Crowder College Occupational Therapy Assistant Program will consider material contained in my criminal history solely for the purposes of determining my suitability for the position of student occupational therapy assistant for which I have applied. I do not authorize release of information for any purposes beyond the program admission decision.

I understand that a prior conviction may not necessarily disqualify me for admission into the program, but will be a factor which may be considered before acceptance into the program. I further understand that a misdemeanor or felony conviction limits and/or prevents clinical placement and employability.

Signature:_____________________________________________________________________

Date: ________________________________________________________________________

Witness: _____________________________________________________________________

**This does not have to be notarized, but signed by an individual that has witnessed your signature.

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REQUEST FOR CRIMINAL RECORD CHECK

Crowder College Occupational Therapy Assistant Program

PLEASE PRINT OR TYPE

Name:______________________________________________________________________________

Last First Middle

Maiden/Alias (if applicable): ____________________________________________________________

Race: (please circle) American Indian/Alaskan Native Asian/Pacific Islander Black/African Hispanic/Latino Middle Eastern/East Indian White/Caucasian

Social Security No.: ___________________________________________________________________

Birthdate: ____________________________________________________________________________ month day year

Address: ____________________________________________________________________________ City ___________________________________________State ________ Zip Code _______________

If at current address less than 1 year, list former address: _________________________________

_________________________________

I authorize the release of any criminal history record information to Crowder College Occupational Therapy Assistant/Allied Health Department.

______________________________________________________________________________________

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LIMITED WAIVER OF CONFIDENTIALITY

By execution of the Occupational Therapy Program application, I do hereby authorize Crowder College or its representatives to verify all information contained within this application, and do waive any privilege I may have as to confidentiality to Crowder College or its representatives, and do authorize any agency, educational, health, or law enforcement to furnish to Crowder College or its representatives the information necessary to validate the information contained upon my Occupational Therapy Assistant application, including a background check for criminal record if any.

___________________________________________ ________________________________

Signature of Applicant Date Submitted

*Application cannot be processed without your signature in ink ACCESS TO RECORDS INFORMATION 10/93

“The Family Educational Rights and Privacy Act of 1974”, Public Law 93-380 as amended and signed into law by President Ford on December 31, 1974, states that enrollees have the right to examine confidential files. It also states that they may waive this right if they do so desire.

The law provides that references may be either confidential or non-confidential at the option of the registrant. The registrant has the option to inspect the references in a non-confidential file. Confidential references are those which the registrant has waived the right to see.

Please consider the following in making a decision to have confidential or non-confidential references. 1. School officials prefer to see confidential references, believing the references are more frank in such credentials. The limited number of studies which have been made of confidential vs. non- confidential references indicate a preference of both hiring officials and college faculty for confidential or enclosed references.

2. Registrants should be most selective in asking persons to write references for them. The persons selected should know the registrant well and be able to state facts and competencies of the registrant.

3. Writers of references will be informed at the time of writing that the reference is confidential or that the registrant will be permitted to see the reference.

CROWDER COLLEGE Occupational Therapy Assistant Allied Health Department Webb City, Missouri 64870



I have elected: ______________ A confidential file.

______________ A non-confidential file.

____________________________________________ __________________________

Signature of Applicant Date

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OCCUPATIONAL THERAPY ASSISTANT PROGRAM

APPLICATION

PERSONAL ESSAY ASSIGNMENT

Complete an essay at least 1 page long but not to exceed 2 pages in length. Essay should be

typed in Times New Roman 12 point font, be double spaced, and utilize correct grammar and

spelling.

Your essay must address the following questions:

1)

Why do you want to pursue a career as an Occupational Therapy Assistant?

2)

What is your personal experience with Occupational Therapy?

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VOLUNTEER/OBSERVATION and REFERENCE FORMS

**The following pages are the forms needed for your Volunteer/Observation

time and for your personal References.

Please provide your Volunteer/Observation supervisor and your

References with a stamped envelope addressed to:

Crowder College Allied Health Department

Occupational Therapy Assistant Program

600 S. Ellis

Webb City, MO 64870

The supervisor/reference person must sign over the envelope seal before

mailing in the forms.

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VOLUNTEER/OBSERVATION FORM

Applicant’s Name:___________________________________________Date:______________ **I am requesting completion of this evaluation form by an individual of my choosing to be used in

the admission selection process for the Occupational Therapy Assistant Program at Crowder College and do hereby waive my right of access to this document.**

Applicant’s Signature:__________________________________________________________ Printed Name of OTR/L or COTA completing this form:_____________________________ Signature of OTR/L or COTA:___________________________________________________ Facility Name:_________________________________________________________________ Address:______________________________________________________________________ Phone Number:________________________________________________________________ Setting:_______________________________________________________________________ Number of Volunteer/Observation hours completed by the applicant at your facility:_____ Time In:________________________________ Time Out:_____________________________ Please use the following scale to rate the behavioral characteristics observed:

Below Expectations (1) Meets Expectations (2) Exceeds Expectations (3)

_____ The applicant demonstrated good time management skills as evidenced by making request for observation hours with appropriate advance notice, arrived promptly on scheduled dates, and remained engaged throughout the scheduled volunteer/observation time.

Comments:

_____ The applicant demonstrated good interpersonal skills during interactions with supervisor,

patients/clients, and others in the facility as evidenced by body language, eye contact, listening skills, and the ability to verbalize thoughts in a clear manner.

Comments:

____ The applicant demonstrated appropriate dress and professional behavior, including emotional maturity during volunteer/observation hours.

Comments:

_____The applicant appeared to have a basic understanding of Occupational Therapy services, asked relevant questions and demonstrated appropriate reasoning and insight.

Comments:

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Please summarize your overall recommendation by checking one of the following: _____Strongly recommend (3)

_____Recommend (2)

_____Recommend with reservations (1) ____ Do not recommend (0) Please Explain: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Signature/Title:__________________________________________________________________________

OTR/L or COTA: Please place this Volunteer/Observation form in the envelope provided by the student.

Seal and place your signature across the seal of the envelope.

Applicant: Please write your name and “Observation Form” on the envelope and return it with your application

packet.

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VOLUNTEER/OBSERVATION FORM

Comments:

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_____Recommend with reservations (1) ____ Do not recommend (0) Please Explain: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Signature/Title:__________________________________________________________________________

packet.

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VOLUNTEER/OBSERVATION FORM

Comments:

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_____Recommend with reservations (1) ____ Do not recommend (0) Please Explain: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Signature/Title:__________________________________________________________________________

packet.

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REFERENCE FORM

Applicant’s Name:________________________________________________________________________ The applicant has chosen this to be a confidential , non-confidential reference.

The above applicant has given this form to you so that you may support his/her application for admission into the Occupational Therapy Assistant Program at Crowder College. The applicant should be someone you have personal knowledge about, but is not a family member. An honest and complete opinion will be most helpful.

Please return this completed form as soon as possible.

1. How long have you known this individual and in what capacity?

2. How well do you know this applicant? ______Very well ______Well ______Not well ______Not at all 3. From your experience with this individual please rate him/her in the following areas :

Communication Coping Commitment to Task Conflict Management Problem-Solving Organization & Planning Grooming Punctuality Very Strong evidence skill is present 4 Strong Evidence skill is present 3 Some evidence skill is present 2 Strong evidence skill is not present 1 Insufficient evidence for or against skill 1/2 Grooming

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4. Would you recommend this person for the OTA program? Yes______________ No _______________

5. Please make a statement regarding what you know about the applicant’s personal characteristics, exceptional qualities, and work ethics.

Signature/Title:__________________________________________________________________________

Please mail this form in the envelope provided by the student.

Thank you.

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REFERENCE FORM

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5. Please make a statement regarding what you know about the applicant’s personal characteristics, exceptional qualities, and work ethics.

Signature/Title:__________________________________________________________________________

Please mail this form in the envelope provided by the student.

Thank you.

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REFERENCE FORM

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5. Please make a statement regarding what you know about the applicant’s personal characteristics, exceptional qualities, and work ethics.

Signature/Title:__________________________________________________________________________

Please mail this form in the envelope provided by the student.

Thank you.

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GRADUATE LEARNING OUTCOMES

1. Provide occupation-based, client-centered care that is inclusive of values, beliefs

and needs.

2. Promote health and wellbeing for individuals and populations through the use of

occupation.

3. Consider evidence-based resources in delivery of client services.

4. Actively participate in and advocate for healthcare change.

5. Identify and address professional ethical challenges by applying the AOTA Code

of Ethics.

6. Recognize and respond to social, economic and political factors that influence and

change occupational therapy services and healthcare.

7. Interact professionally with consumers, caregivers, families and/or professional

colleagues to achieve service objectives.

8. Interact and collaborate, directly and indirectly, with personnel needed to provide

comprehensive occupational therapy services.

9. Demonstrate effective communication practices needed to function effectively as

a member of an inter-professional healthcare team.

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Program Curriculum Plan

Associates of Science Degree

Total credit hours - 72

Pre-Admission

ENGL 101 English Composition-3 credit hours PSYC 101 General Psychology-3 credit hours

BIOL 152 Human Anatomy and Physiology I-5 credit hours COLL 101 College Orientation -1 credit hour

SPCH 101 Fundamentals of Speech-3 credit hours

Total: 15 credit hours Spring

OTA 101 Principles of Occupational Therapy-2 credit hours

OTA 111 Occupational Performance Across the LifeSpan-3 credit hours OTA 116 Principles of Therapeutic Intervention-2 credit hours

BIOL 252 Human Anatomy and Physiology II-5 credit hours OA 215 Medical Terminology-3 credit hours

Total: 15 credit hours Summer

MATH 111 College Algebra or Math 107-3 credit hours HIST 106 U.S. History 1 or PLSC 103-3 credit hours

Total: 6 credit hours Fall

OTA 201 Principles of Occupational Therapy Practice: Children and Adolescents-5 credit hours OTA 131 Functional Movement: Occupation and Adaptation-3 credit hours

OTA 140 Occupational Therapy Trends and Issues-2 credit hours

Humanities 3 credit hours (Recommend: Cultural Diversity HUM 102 or Critical Thinking PHIL 110)

Total: 13 credit hours Spring

OTA 211 Principles of Occupational Therapy Practice: Mental Health-5 credit hours

OTA 221 Principles of Occupational Therapy Practice: Physical Rehabilitation-5 credit hours OTA 236 Occupational Performance Issues in Later Adulthood-3 credit hours

Total: 13 credit hours Fall

OTA 240 Fieldwork level II A-5 credit hours OTA 250 Fieldwork level II B-5 credit hours

Total: 10 credit hours

Total Hours: 72 credit hours

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Tuition, Fees, and licensure Tuition

In district: General Education Classes $82.00 per semester hour x 32= $2,624.00 OTA Classes $99.00 per semester hour x 40=$3,960.00

Facility Use Fee $16.00 per semester hour x 72=$1,152.00 Total in district tuition: $7,736.00

Out of district: General Education classes $122.00 per semester hour x 32=$3,904.00 OTA Classes $145.00 per semester hour x 40=$5,800.00 Facility Use Fee $16.00 per semester x 72=$1,152.00 Total Out of district: $10,856.00

Pre-Admission

Application Fee* $40.00

Criminal Background check * $52.50 Physical Exam and Immunizations * $100.00

TB Test * $20.00 CPR Certification* $55.00 Total $267.50 Spring 1st_year Polo Shirt * $20.00 Drug Screen $20.00 Lab Fee $50.00

Textbooks * $1,500.00 (approximate amount for all semesters) Total $1,590.00

Fall 1st_year

Lab coat (if required by site) * $20.00

Lab fee $50.00 Total $70.00 Spring 2nd_year Liability Insurance $13.00 Lab Fee $150.00 TB Test* $20.00 Drug Screen $20.00 Total $203.00 Fall 2nd_year Graduation Fee * $35.00 Liability Insurance $13.00 Pictures (optional)* $20.00 School Pin $45.00

Exam Review and book $200.00

Lab Fee $15.00 Total $328.00 Licensure Fees

NBCOT Exam Fee * $500.00

State Score reporting fee * $40.00 Confirmation of Exam Registration * $45.00 Missouri Limited Permit* $15.00 Missouri full licensure* $30.00 Total $630.00 Total estimated in district cost $ 13,377.50 Total estimated out of district cost $ 16,497.50 (All charges are an estimated cost and is subject to change)

Occupational Therapy Assistant Program