OCCUPATIONAL THERAPY DEPARTMENT

OCCUPATIONAL THERAPY DEPARTMENT APPLICATION PACKET This completed form and all supporting documents should be submitted to: The University of Tennessee at Chattanooga 615 McCallie Avenue The Graduate School, Department 5305 Chattanooga, TN 37403 The process for admission into the Occupational Therapy Doctorate program is competitive. Completion of minimum requirements does not guarantee acceptance into the Occupational Therapy Doctorate program. MINIMUM REQUIREMENTS FOR ADMISSION 1. Admission to The University of Tennessee at Chattanooga Graduate School. Submit the Graduate School application and $30 application fee to UTC at the following website: https://ssb.utc.edu/cbanpr/bwskalog.p_disploginnon 2. Submission documents requested below and the Application Supplement. Include the following: GRE scores: GRE scores must be submitted to the Graduate School. UTC school code is 1831. Official transcripts from an accredited college or university with a minimum 3.0 undergraduate grade point average (GPA). Degrees in progress will be considered. Prerequisite Completion Plan: If you have not received an undergraduate degree this form must be completed to describe your plan for completion of all prerequisites prior to the start of classes in August 2013. Official transcripts for pre-requisites showing courses were completed within the last 10 years and that a minimum grade of C have been earned in each of the pre-requisite classes (C- will not be accepted). There will be no substitutions made for the required courses. A minimum of three letters of recommendation from professional and/or academic contacts. Each from a person with authority regarding your work and accessing your qualifications for graduate education, ability to complete graduate work, and your qualifications for a professional scholarly career. These may include professors, therapists, and/or other professionals familiar with your capabilities and achievements. Essay: Submit an essay describing your interests and skills, goals and professional accomplishments, including why you are choosing a graduate degree and your current understanding of the profession of Occupational Therapy. For more information, contact the appropriate department listed below: Occupational Therapy Department Phone: 423-425-2357 Ms. Cathy Eppinger, Administrative Assistant Email: cathy-eppinger@utc.edu Website: http://www.utc.edu/academic/occupationaltherapy/ UTC Graduate School Phone: 423-425-1780 Mr. Mark Fairchild, Program Liaison Email: mark-fairchild@utc.edu Website: http://www.utc.edu/administration/graduateschool/index.php

Applicant Name: OCCUPATIONAL THERAPY DEPARTMENT OCCUPATIONAL THERAPY APPLICATION SUPPLEMENT E-mail: Permanent Address: Phone contact: VERIFICATION OF UNDERSTANDING AND INTENTION I understand that withholding information requested in this application or giving false information may make me ineligible for admission to or continuation in the Occupational Therapy Doctorate program at The University of Tennessee at Chattanooga. Initials: I understand that I must pay for and complete a criminal background check and drug screening in order to complete the program. I also understand that a felony conviction or positive drug test may affect my ability to sit for the NBCOT Board Exam and/or to attain state licensure. Initials: I understand that I need to have earned a bachelor s degree prior to starting the OTD program. I earned my bachelor s degree on (mo/yr) or will be completing my bachelor s degree on (mo/yr). My current cumulative GPA is. Initials: Academic Preparation: Pre-requisite course completion (8 of 11 must be completed by Feb 15, 2013.) Program Requirement Req. Credits General Psychology 3 Course Number and Title Institution Term & Year Grade Abnormal Psychology 3 Developmental Psychology 3 covering the lifespan Anatomy and Physiology I 4 Anatomy and Physiology II 4 Statistics 3 Medical Terminology 1-3 Physics with lab 4 Introductory course in 3 Sociology or Anthropology Biology with labs 8 Chemistry with lab 4 For any missing classes, please complete the "Proposed Plan for Completion of Pre-Professional Courses" form on the following page.

Occupational Therapy Department PROPOSED PLAN FOR COMPLETION OF PRE-PROFESSIONAL COURSES** Name: Home Telephone: UTC ID (if applicable): School Telephone: Institution Currently Attending: Institution Planned for Completion of Pre-Professional Courses: Term 20-20 Term 20-20 Course# Title Credit Hrs. Course# Title Credit Hrs. Course# Title Credit Hrs. Course# Title Credit Hrs. I have completed all pre-professional coursework. I plan to complete my pre-professional coursework in (month) 20. I (am ) (am not ) working toward a degree. Planned date of graduation: **This form needs to be returned to us as soon as possible. Please enumerate all courses in which you are CURRENTLY ENROLLED and any which you are planning to take in subsequent terms. Return this form with your application. November, 2012

Evaluation Form Supporting Application for Admission to the UTC OTD Program Instructions to Applicants After completing the identifying information in the spaces below, distribute the appropriate number of forms to instructors and others who are qualified to evaluate your qualifications for graduate study. Number of Forms Required: Three UTC ID (if applicable) Degree & Major Sought Applicant's E-mail Address Applicant's Phone Number Applicant's First Name Applicant's Middle or Maiden Name Applicant's Last Name Applicant's Address In accordance with the Family Education Rights and Privacy Act of 1974, applicants may waive their right to see letters of recommendation. Please indicate your choice and sign on the appropriate line below. If you choose to retain your right, you may read this recommendation if you enroll in the UTC OTD Program. I waive my right to see this recommendation. I retain my right to see this recommendation. Signature Date Evaluator: Request to Evaluator How long and in what capacity have you known the applicant? Please compare this applicant with others you have recommended to graduate study: Depth of Knowledge in Proposed Field of Study Motivation and Initiative Diligence and Perseverance Independence Creativity Integrity Emotional Stability Verbal Clarity Writing Skills Teaching Ability Research Ability Overall Intellectual Capability 5% 10% 25% 50% Bottom 50% No Basis to Judge Please complete both sides of this form. The University of Tennessee at Chattanooga is an equal employment opportunity/affirmative action/title VI/Title IX/Section 504/ADA/ADEA institution. Inquiries should be directed to the Office of Equity and Diversity (OED), 201 Human Resources Center, Dept. 5455, 615 McCallie Ave, Chattanooga, TN 37403-2598.

In the space below, please provide a written assessment of this applicant's potential to complete a graduate-level program. Be as specific and candid as possible, commenting on strengths and weaknesses and providing examples of the skills and characteristics that you believe are relevant to our decision. Attach an additional sheet if necessary. Name of Evaluator Title Place of Employment Address Phone Number E-mail Address Signature Date All recommendations should be mailed directly to the UTC Graduate School, Dept. 5305, 615 McCallie Avenue, Chattanooga, TN 37403-2358.

OCCUPATIONAL THERAPY DEPARTMENT POLICY ON TECHNICAL STANDARDS Please note: This information is sent to you with the application packet for your information only. If you are admitted to our program and you intend to accept the admission offer and enroll in our program, you will be required to complete a separate form so that proper accommodations may be made for you as necessary. The Admissions Committee will consult with applicants who indicate that they cannot meet the technical standards with or without reasonable accommodation. The faculty responsible for the academic program and the members of the Admissions Committee may seek advice in each individual situation from UTC's Disability Resource Center (http://www.utc.edu/administration/disabilityresourcecenter/ ). A doctoral degree in Occupational Therapy signifies that the holder is prepared to assume leadership in the field of Occupational Therapy. It follows that graduates must have the knowledge and skills to articulate theory and perform advanced, evidence-based practice. Therefore, all individuals admitted to UTC's OTD degree program must have the following abilities and expectations with or without accommodations. Individuals with disabilities are encouraged to apply to the program, and reasonable accommodation will be made for qualified applicants or students who disclose a disability. Applicants who state that they have a disability or who are observed to have a disability will be considered for admission if they are otherwise qualified for the program. Candidates who indicate upon application or after acceptance to the program that they cannot meet an expectation listed will be reviewed further by the Admissions Committee, with faculty input, to determine if reasonable accommodations are likely to lead to successful completion of the occupational therapy graduate program. 1. Problem Solving: The culminating activity in the preparation of an occupational therapist is clinical reasoning. The doctoral occupational therapy student is expected to develop advanced expertise and demonstrate research skills. Therefore, a candidate must be able to conduct research, to make correct observations, and have the skills of measurement, calculation, reasoning, analysis, and synthesis. 2. Judgment: The candidate will be expected to demonstrate judgment in classroom and research settings which shows an ability to make mature, sensitive, and effective decisions in the following areas: a) relationships with supervisors, peers, and patients/clients; b) professional behavior; and c) the effectiveness of intervention and research strategies. He or she must demonstrate an understanding of the rationale and justification for his or her performance. 3. Communication: a) Written communication: The candidate must be able to assimilate information from written sources (texts, journals, medical/school records, etc.). The candidate must be able to attain, comprehend, retain, and utilize new information presented in written formats. Candidates are required to use information from written sources and must be able to produce appropriate written documentation. b) Verbal and nonverbal communication: Candidates must be able to produce the spoken word and to elicit information from patients/clients, supervisors, and peers with skills in describing not only factual information, but the more subtle cues of mood, temperament, and social responses. Communication with patients/clients and all members of the intervention or academic team must be accurate, sensitive, effective, and efficient. Response time to emergencies/crisis situations, as well as more routine communication, must be appropriate to the situation or setting. 4. Sensorimotor: Candidates must have gross motor, fine motor, and equilibrium functions as well as a functional use of the senses of vision, hearing, and the tactile sense that will enable them to perform the career tasks which are the target of their career paths. 5. Behavioral and social attributes: Candidates are expected to exhibit professional behaviors and attitudes during their participation in classroom, clinical, and research experiences. This includes, but is not limited to, appropriate language, flexibility regarding change, and acceptance of responsibility for one s own conduct. Students are expected to exhibit a positive attitude toward patients/clients, peers, and supervisors.