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Occupational TherapyAssistant ProgramApplication PacketOccupational TherapyAssistant ProgramApplication PacketDear Future Clinician,Thank you for taking the first step in changing your life by seeking interest into the Occupational Therapy Assistant program at Dallas College at Mountain View Campus!! 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 Campus Occupational Therapy Assistant program and all the forms needed for application to the program. Dallas College at Mountain View Campus 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 Dallas College Mountain View Campus. Applicants must meet all the admission criteria for Dallas College at Mountain View Campus 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 February 1st and end April 1st. Applications will be accepted beginning February 1st and must be delivered by April 1st. If you have questions about the occupational therapy assistant program or the admissions process, please contact the Occupational Therapy Assistant Department at 214-860-3605 or email OTA Dr. Candice Freeman at candicefreeman@dcccd.edu . We look forward to working with you. Sincerely, Occupational Therapy Assistant Program FacultyGeneral InformationACCREDITATIONThe 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 . *Mountain View's OTA program is accredited by?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?.LOCATIONOccupational therapy assistant courses are offered only at Dallas College at Mountain View Campus. ADMISSIONA new class of students are admitted into the Occupational Therapy Assistant Program each fall. The program will accept 14 students each fall and possibly spring (pending approval). Current dates for admission can be found in this packet. Late applications or inquiries will not be considered for admission. PROGRAM COURSESOTA 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. GRADESThe OTA program will follow the Nursing/Allied Health Department grading system listed below:Grading Percentages92%-100%84%-91.9%75%-83.9%68%-74.9%67% & BelowLetter GradeABCDFStudents must earn a “75” or above in all OTA coursework in order to progress in the program. FEESStudents 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 CODEStudent professional dress is expected for all classroom and clinical activities. CLASSROOM/LEVEL I FIELDWORK: Students are expected to wear red scrubs (undershirts may be worn), white lab coat, closed-toe tennis shoes (slip-resistant) and campus nametag. An optional jacket (ordered for our approved uniform vendor (colors red or black for women; black for men) is also considered. No hoodies or overcoats are to be worn in class/lab. You will use your OTA jacket or lab coat as a substitution. Nametags from Mountain View Campus OTA program should be worn at all times.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 Campus 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. An MVC name badge will be worn with the uniform on the scrub top. Mountain View Campus (logo)” and the student’s name must be embroidered on the left side of the top/shirt and lab coat.Jewelry and cologne are to be kept to a minimum. No tattoos are allowed to be seen or show.?Coverings and other suggested surgical head caps may be worn as directed by the OTA Program Director. Piercings allowed are a single pair of ear studs for women only. All other piercings on men and women must be removed prior to entering OTA classrooms and off-campus sites (including clinical and fieldtrips). Make up should be usual and routine reflecting modesty and consideration of a range of?client ages a learner may encounter. Hair color that is natural is allowed?so long as it is not distracting to other learners or clients. Colors such as purples, yellows, blues are never allowed. If there is a question, ask the program director PRIOR to paying for hair coloring. The program director will give?a direct answer?to questions about hair colors or styles. If professional dress code is not followed the learner will receive a 0-assignment grade for the day, will not be allowed to accompany the class on assignment and will not have an option to makeup the assignment.CRIMINAL HISTORY, BACKGROUND CHECK, AND DRUG SCREENINGThe 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, AND the Executive Council for Physical Therapy and Occupational Therapy 512-305-6900, ecptote.state.tx.us to determine your certification and licensure eligibility.? It is your responsibility to have letters of verification sent directly to the program director from each of the above entities noting your eligibility in order for your application to be considered.? These letters must be received by the program by the application deadline.IMMUNIZATIONSStudents will be required to submit required proof of current immunizations. PERSONAL HEALTH INSURANCEStudents are required to carry personal health insurance and show proof of insurance prior to enrollment in the OTA program. PROFESSIONAL LIABILITY INSURANCEStudents 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 REQUIREMENTSThe 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. PROPOSED CURRICULUMOCCUPATIONAL THERAPY ASSISTANT, AAS2021 (Spring 2021)*All applicants must have a GED or High School diploma to apply**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 SEMESTERLECHrsLABHrsEXTHrsCONTHrsCRHrsENGL-1301 Composition I300483PSYC-2301 General Psychology300483BIOL-2401 Anatomy & Physiology I330964+ an Elective Humanities/Fine Arts300483TOTAL Semester Hours:123024013SEMESTER ILECHrsLABHrsEXTHrsCONTHrsCRHrsBIOL-2402 Anatomy & Physiology II330964PSYC-2314 Lifespan Growth & Development300483OTHA-1305** Principles of Occupational Therapy240963OTHA-1315 Therapeutic Use of Occupations & Activities I240963TOTAL Semester Hours:1011033613SEMESTER IILECHrsLABHrsEXTHrsCONTHrsCRHrsOTHA-2301 Pathophysiology in Occupational Therapy220643OTHA-1319 Therapeutic Interventions I240963OTHA-2209 Mental Health in Occupation Therapy200322OTHA-2302 Therapeutic Use of Occupations & Activities II240963OTHA-1161 Occupational Therapy Assistant Clinical Adults003481OTHA-1349 Occupational Performance in Adults240963TOTAL Semester Hours:1014643215SEMESTER IIILECHrsLABHrsEXTHrsCONTHrsCRHrsOTHA-1162 Occupational Therapy Assistant Clinical-Pedi003481OTHA-1341 Occupational Performance in Pediatrics240963OTHA-1163 Occupational Therapy Assistant Clinical-Elders003481OTHA-1253 Occupational Therapy Performance in Elders210482OTHA-2235 Health Care Mgmt. in Occupational Therapy210482OTHA-2331 Physical Function in Occupational Therapy240963OTHA-2305 Therapeutic Interventions II240963TOTAL Semester Hours:1014648015SEMESTER IVLECHrsLABHrsEXTHrsCONTHrsCRHrs*OTHA-2266 Practicum for Occupational Therapy Assistant00203202*OTHA-2267 Practicum for Occupational Therapy Assistant*00203202TOTAL Semester Hours:00406404GRAND TOTAL======212860Admission ProcessInstructions for Applying to the OTA ProgramAdmission to Dallas College:The following documents need to be on file for Mountain View College prior to application to the OTA program:Apply for admission into Dallas College at Admissions & RegistrationCompletion of the four prerequisite courses with a minimum grade point average of 2.75 or higher (all courses must be completed with a grade of C or better).Submit all official transcripts from colleges/universities other than Mountain View College to the Office of Enrollment Services at Mountain View College. If you have any questions about transcripts, please speak to Ms. Rebecca Soto at 214-860-8602 or email her at RebeccaSoto@dcccd.eduTake the ATI TEASE Assessment Test and score a 65 or higher. (Check website for testing dates and tease info) Dallas College Admission ProcessMeet the physical and mental standards for admission Complete all required immunizations and TB testingHold a current CPR Healthcare Provider-level certificateHave a negative background check submitted with OTA application and a negative drug test screeningProof of medical insuranceComplete and submit all required paperwork*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 is vital 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 Application Forms*Place the above materials and your official transcripts in a 9"x12" envelope for submission in person. The envelope must be received in the OTA Office (located ground floor in the W/H building) at Dallas College at Mountain View Campus by the deadline found on the application. Please type or print legibly in black ink._____________________________________________________________________________________Social Security #:MVC ID#:Texas Driver’s License#:DL EXP Date:_____________________________________________________________________________________Last Name:First Name:MI:_____________________________________________________________________________________Mail Address:Street: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 DD/MM/YYYY:Age:Gender:MaleFemaleEthnicity: FORMCHECKBOX Hispanic FORMCHECKBOX Caucasian/White FORMCHECKBOX 2 or more Races FORMCHECKBOX Native Hawaiian/Pacific Islander FORMCHECKBOX UnknownHealth Insurance: FORMCHECKBOX Yes FORMCHECKBOX NoName of Insurance Company: _________________________________________________________________________________________________________________Emergency Contact:Last Name:First Name:Phone:Do you have a FORMCHECKBOX High School Diploma or FORMCHECKBOX GED?Month/Year MM/YYYY Awarded? ___________*All Applicants must have a GED or High School Diploma to Apply._____________________________________________________________________________________Highest Degree Earned:Month/Year MM/YYYY Awarded:Have you previously accepted or enrolled in another OT or OTA Program? FORMCHECKBOX Yes FORMCHECKBOX No, FORMCHECKBOX OT or FORMCHECKBOX OTA.If yes, please list the school(s) under prior education. _________________________________________Can we notify the school(s)? FORMCHECKBOX Yes FORMCHECKBOX NoPrior Education (List most recent first…)GED Program,High School, Colleges AttendedLocation(City, State, Zip)Graduation Date From/To MM/YY/MM/YYHours EarnedDate Degree Earned*Again, All Applicants must have a GED or High School Diploma to Apply.Employment Record (list most recent or present position)Company NameDate(s) EmployedPosition & DutiesPrerequisite Requirement TableCourse Name &NumberSemester & YearFinal GradeSchool where Course was takenENGL-1301 Composition IPSYC-2301 General PsychologyBIOL-2401 A&P I (Lecture/Lab)+ Elective Humanities/Fine Arts (MUST be selected from the AAS Core options for Humanities/Fine ArtsObservation Hours: Please fill out the following information AND submit signed Hours of Observation Form. (40 Hours Total (20 Hours in two different areas/settings)).Name of FacilityType of SettingNumber of HoursHealth Record_____________________________________________________________________________________Last Name:First:Middle:DOB: (DD/MM/YYYY)Date:_____________________________________________________________________________________Address:Street:City: & State:Zip Code:_____________________________________________________________________________________Telephone:Home:Work:Cell or VM:Health QuestionnaireTo be filled out by the ApplicantI certify that I have: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_ FORMCHECKBOX _ No_ FORMCHECKBOX _ If No, Explain: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________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_ FORMCHECKBOX _ No_ FORMCHECKBOX _ If No, Explain: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________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_ FORMCHECKBOX _ No_ FORMCHECKBOX _ If No, Explain: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________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_ FORMCHECKBOX _ No_ FORMCHECKBOX _ If No, Explain: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Manual dexterity, strength, gross motor, and fine motor skills. This includes but is not limited to the ability to utilize sterile technique, turn, and move patients, and perform other OTA procedures/skills. Yes_ FORMCHECKBOX _ No_ FORMCHECKBOX _ If No, Explain: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Reliable personal transportation and ability to attend all classroom and clinical experiences, both on and off campus. Yes_ FORMCHECKBOX _ No_ FORMCHECKBOX _ If No, Explain: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________A normal level of health and immunity. This includes but is not limited to the ability to tolerate immunizations and to work with a wide variety of potentially contagious patients. Yes_ FORMCHECKBOX _ No_ FORMCHECKBOX _ If No, Explain: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Ability to function safely and professionally under various stressful conditions. Yes_ FORMCHECKBOX _ No_ FORMCHECKBOX _ If No, Explain: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________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 random drug and alcohol screenings. If drug/alcohol 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_ FORMCHECKBOX _ No_ FORMCHECKBOX _ If No, Explain: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Please answer the following questions: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_ FORMCHECKBOX _ No_ FORMCHECKBOX _ If No, Explain: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Do you have any other conditions which might interfere with your ability to practice occupational therapy? Yes_ FORMCHECKBOX _ No_ FORMCHECKBOX _ If No, Explain: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________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 of paper. Make sure your name and ID number are at the top of the page).____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________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 NurseChest X-Ray within one year if PPD positive:_____________________________________________________________________________________Date:Results:_____________________________________________________________________________________Signature: PhysicianUpdates of tuberculosis screening will be required every 12 months while enrolled in the Dallas College at Mountain View Campus OTA Program.Record of Required ImmunizationsList 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.VaccinationsDates of Completed SeriesTiter where appropriateCopies of Records presented to MVC OTA ProgramCommentsMeasles – 2 doses since 12 months of age if born prior to January 1, 1957, or verification of immunity.Mumps – 1 dose since 12 months of age if born prior to January 1, 1957, or verification of immunity.Rubella – 1 dose since 12 months of age or verification of immunity. Individuals born prior to January 1, 1957, are NOT exempt.TDAP –1 dose within past 10 yrs.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.Hepatitis B Vaccine Series must be completed before any clinical rotation or positive titer if series previously completed.Initial dose: One (1) month:Six (6) months:__________________________________________________________________________________________No student may begin the OTA program without verification of immunization status.PHYSICAL EXAMINATION To be completed by physician, nurse practitioner or physician assistant._____________________________________________________________________________________NAME, Last:First:Middle:Date:Sex:_____________________________________________________________________________________HEIGHT:WEIGHT:TPR:BP:HEARING:_____________________________________________________________________________________VISION:GLASSES:CONTACT LENSES: RLHISTORY(Attach separate sheet if needed) Include any significant information regarding pertinent medical and surgical conditions and use of alcohol and/or drugs.GENERAL APPEARANCECheck each item in appropriate columnNormalAbnormalDescribe each abnormality in detail (attach additional sheets if necessary)Eyes, Ears, Nose, Throat, Mouth, Teeth, Neck FORMCHECKBOX FORMCHECKBOX Heart and Vascular FORMCHECKBOX FORMCHECKBOX Lungs FORMCHECKBOX FORMCHECKBOX Abdomen and Viscera FORMCHECKBOX FORMCHECKBOX Back, Vertebrae FORMCHECKBOX FORMCHECKBOX Extremities FORMCHECKBOX FORMCHECKBOX Skin FORMCHECKBOX FORMCHECKBOX Neurological FORMCHECKBOX FORMCHECKBOX 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.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: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.Checklist for OTA ApplicantsDate: _________Name: __________________________________Student 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?? Scheduled to take your TEASE Test prior to OTA Deadline? 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? 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.____________________________________________________________Student Signature:Date:This application will be used in the accumulation of points for the admission process. Students admitted are aware that Dallas College at Mountain View Campus is in Accredited per ACOTE. 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 Dallas College at Mountain View Campus- 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.AppendicesAdmission Worksheet RubricOccupational Therapy Assistant Observation Feedback FormLetter of Recommendation Form (turn in 3 recommendation forms)Appendix A_____________________________________________________________________________________Student Name:Student ID#:Application Semester: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.Appendix BObservation/Volunteer RecordOccupational Therapy Assistant ProgramSubmit one form for each facility in which observation/volunteer hours were completed._____________________________________________________________________________________Applicant Name (Please PRINT):This applicant has observed/volunteered ____________ hours under my supervision.Name and Credentials: __________________________________________________________________License#: ___________________________________State: _________________________________Facility Name: _________________________________________________________________________Address: _____________________________________________________________________________Phone Number: _____________________________Email: _________________________________Volunteer ReviewSuperior (5)Good (4)Average (3)Below Average (2)Poor (1)Arrived of Time FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Appropriately Dressed FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Interaction with Staff FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Interaction with Clients/Patients FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX 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:Date:Appendix CLetter of RecommendationOccupational Therapy Assistant ProgramApplicant’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 Dallas College – Mountain View Campus, I waive my right to access to the document._____________________________________________________________________________________Signature:Date:_____________________________________________________________________________________Name of Individual Completing Form: _____________________________________________________________________________________Phone Number:Email Address:_____________________________________________________________________________________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:SuperiorAbove AverageAverageBelow AveragePoor#54321Evaluation AreaRatingAttitude 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, posure: 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: (You may include addition sheets of paper)__________________________________________________________________________________________________________________________________________________________________________CONTACT INFORMATONDr. Candice Freeman OTD, MOT, OTR/LProgram Director- Dallas College at Mountain View Campus Occupational Therapy Assistant Program Physical Address:4849 W. Illinois Avenue, Dallas, Texas75211Office: W-29 SuitePhone:214-860-3605 (main office number)Fax: 214-860-8880 (call before faxing)Program Website: Occupational Therapy Assistant ................
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