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Supplemental Application for Western Michigan University’sOccupational Therapy Doctorate (OTD) ProgramSummer II 2020 EntryName: FORMTEXT ????Mailing Address, City, State, Zip: FORMTEXT ?????Current Daytime Telephone: FORMTEXT ?????Email Address: FORMTEXT ?????Western ID Number (WIN) – for previous WMU students: FORMTEXT ?????Please check the box indicating your FIRST location preference: FORMCHECKBOX Kalamazoo FORMCHECKBOX Grand RapidsCHECKLIST FOR SUBMISSION – Please read each statement carefully. Each item must be checked off to be considered for admission: FORMCHECKBOX I understand that my application must be submitted AND complete by 11:59pm ET on January 15. This includes official transcripts, GRE scores, this supplemental OTD application, and any other required materials of the graduate admissions process. Please plan ahead to ensure that all materials arrive to WMU prior to the January 15 deadline. Any missing application documents or transcripts as of January 16 will be considered late and will not be reviewed. FORMCHECKBOX I have submitted ALL official transcripts to the WMU Admissions Office – we must have official transcripts from ALL previous institutions attended (except for WMU), including your most recent work completed prior to the January 15 deadline. We will NOT accept late or unofficial transcripts. FORMCHECKBOX I understand all of my prerequisites (or equivalents) with a grade of C (2.0) or better must be completed before the January 15 deadline. FORMCHECKBOX I have submitted my official GRE scores to the WMU Admissions Office, using school code: 1902. I also understand that unofficial GRE scores will NOT be accepted. FORMCHECKBOX I understand my GPA must be a 3.0 minimum (approximately the last 60 credit hours will be calculated for graduate admission, without splitting a semester). FORMCHECKBOX I understand this program application does not require a specific number of job shadowing/observation hours. However, we expect all applicants to have a broad and thorough understanding of the profession. FORMCHECKBOX I understand that I may be invited to campus for an interview as part of the OTD application process and any related expenses will be my responsibility. FORMCHECKBOX My bachelor’s degree will be completed by June 1, prior to the Summer II start date of the OTD program. FORMCHECKBOX I understand that if I have previously attended an Occupational Therapy Program, I must disclose this immediately. I further understand that a letter of good standing from my previous institution will be required in order to begin the OTD program at WMU. FORMCHECKBOX I understand that if I have previously been charged or convicted of a felony, I must disclose this immediately. I further understand that this can impact my ability to begin the program. A background check and drug screen will be required before the start of the Summer II semester. FORMCHECKBOX I understand that there are multiple medical requirements necessary for me to be enrolled in the OTD program at WMU, which include but are not limited to immunizations, CPR/First Aid, Health Insurance. (Further information will be emailed to admitted students shortly after admission).It is the policy and commitment of Western Michigan University not to discriminate on the basis of race, sex, age, color, national origin, height, weight, marital status, familial status, sexual orientation, religion, disability, or veteran status in its educational programs, student programs, admissions, or employment policies.Note: A felony conviction may affect a student’s eligibility to be placed on Level I or II fieldwork, as well as apply to take?the National Board for Certification in Occupational Therapy Examination for OTR and apply for a state license to practice as an Occupational Therapist.Electronic/Typed Signature: FORMTEXT ????? Date: FORMTEXT ????? Prerequisite CoursesAll prerequisite courses must be completed with a C (2.0) or better prior to the application deadline.HSV 2250: Growth, Development, & AgingCourse Taken: FORMTEXT ????? Semester Taken: FORMTEXT ????? Where: FORMTEXT ????? Grade: FORMTEXT ?????PSY 1000: General PsychologyCourse Taken: FORMTEXT ????? Semester Taken: FORMTEXT ?????Where: FORMTEXT ????? Grade: FORMTEXT ?????PSY 2500: Abnormal PsychologyCourse Taken: FORMTEXT ????? Semester Taken: FORMTEXT ????? Where: FORMTEXT ?????Grade: FORMTEXT ?????BIOS 2110: Human AnatomyCourse Taken: FORMTEXT ????? Semester Taken: FORMTEXT ?????Where: FORMTEXT ?????Grade: FORMTEXT ?????BIOS 2400: Human PhysiologyCourse Taken: FORMTEXT ????? Semester Taken: FORMTEXT ????? Where: FORMTEXT ????? Grade: FORMTEXT ?????STAT 3660: Data Analysis for Biosciences or STAT 1600: Statistics and Data AnalysisCourse Taken: FORMTEXT ????? Semester Taken: FORMTEXT ????? Where: FORMTEXT ????? Grade: FORMTEXT ?????MDSC 2010: Medical TerminologyCourse Taken: FORMTEXT ????? Semester Taken: FORMTEXT ????? Where: FORMTEXT ????? Grade: FORMTEXT ?????Work/Volunteer ExperiencesPlease list work and/or volunteer experiences involving helping others from disabled, culturally diverse, vulnerable populations. You may also list any occupational therapy-related experiences (job shadowing, volunteering, etc.) in this section:Agency/Organization: FORMTEXT ?????Summary of Participation: FORMTEXT ?????Dates of Participation: FORMTEXT ?????Hours Worked: FORMTEXT ?????Agency/Organization: FORMTEXT ?????Summary of Participation: FORMTEXT ?????Dates of Participation: FORMTEXT ?????Hours Worked: FORMTEXT ?????Agency/Organization: FORMTEXT ?????Summary of Participation: FORMTEXT ?????Dates of Participation: FORMTEXT ?????Hours Worked: FORMTEXT ?????Leadership/TeamworkPlease list your leadership and/or teamwork experiences, both paid and unpaid:Summary of Participation: FORMTEXT ?????Dates of Participation: FORMTEXT ?????Total Hours: FORMTEXT ?????Summary of Participation: FORMTEXT ?????Dates of Participation: FORMTEXT ?????Total Hours: FORMTEXT ?????Summary of Participation: FORMTEXT ?????Dates of Participation: FORMTEXT ?????Total Hours: FORMTEXT ?????Diversity ExperiencePlease list any courses taken that included substantial study of other cultures:Course Taken: FORMTEXT ????? Semester Taken: FORMTEXT ????? Where: FORMTEXT ?????Course Taken: FORMTEXT ????? Semester Taken: FORMTEXT ????? Where: FORMTEXT ?????Course Taken: FORMTEXT ????? Semester Taken: FORMTEXT ????? Where: FORMTEXT ?????Please list any college-level non-English language or sign language courses taken:Course Taken: FORMTEXT ????? Semester Taken: FORMTEXT ????? Where: FORMTEXT ?????Course Taken: FORMTEXT ????? Semester Taken: FORMTEXT ????? Where: FORMTEXT ?????Course Taken: FORMTEXT ????? Semester Taken: FORMTEXT ????? Where: FORMTEXT ?????Please discuss any sustained interactions and/or experiences involving diversity and inclusion and any cultures other than your own: FORMTEXT ?????Research CoursesPlease list college-level research courses taken:Course Taken: FORMTEXT ????? Semester Taken: FORMTEXT ????? Where: FORMTEXT ?????Course Taken: FORMTEXT ????? Semester Taken: FORMTEXT ????? Where: FORMTEXT ?????Course Taken: FORMTEXT ????? Semester Taken: FORMTEXT ????? Where: FORMTEXT ?????Research ExperiencesList formal research projects for which you helped formulate a research plan, collected data, or analyzed data:Project Title: FORMTEXT ?????Your Role/Duties: FORMTEXT ?????Date of Project: FORMTEXT ?????Further Explanation of Research Experience: FORMTEXT ?????Project Title: FORMTEXT ?????Your Role/Duties: FORMTEXT ?????Date of Project: FORMTEXT ?????Further Explanation of Research Experience: FORMTEXT ?????Project Title: FORMTEXT ?????Your Role/Duties: FORMTEXT ?????Date of Project: FORMTEXT ?????Further Explanation of Research Experience: FORMTEXT ?????If you have any questions or need clarification as you complete this application,please contact Sarah Anderson, Manager of Recruitment and Outreach, at sarah.anderson@wmich.edu or (269) 387-8987.End of Supplemental OTD Application ................
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