School of Health SciencesOccupational Therapy Assistant ProgramApplication Packet

OTA PROGRAM APPLICATION PACKETDear Prospective Occupational Therapy Assistant Student:Thank you for your interest in the future Occupational Therapy Assistant (OTA) Program at Hawkeye CommunityCollege. The need for skilled, practice-ready occupational therapy assistants continues to grow. OTAs can look forwardto dynamic careers working in multiple settings with people of all ages, fostering their independence to participate in lifeto its fullest.The OTA Program at Hawkeye Community College has been designed to offer stimulating and rigorous classroom andclinical experiences for all students, from young adults pursuing their first career to adults who have been out of schoolfor some time or those who are changing careers.The Occupational Therapy Assistant program at Hawkeye Community College has been granted accreditation by theAccreditation Council for Occupational Therapy Education (ACOTE) of the American Occupational Therapy Association(AOTA).Graduates will be eligible to sit for the national certification examination for the occupational therapy assistantadministered by the National Board for Certification in Occupational Therapy (NBCOT) once all didactic and fieldworkrequirements are completed with passing grades.American Occupational Therapy Association, Inc.4270 Montgomery Lane, Suite 200P.O. Box 31220Bethesda, MD 20824-1220301-652-6611 [email protected] Board for Certification inOccupational Therapy800 S. Frederick Avenue, Suite 200Gaithersburg, MD 20877-4150301-990-7979www.nbcot.orgWe are glad that you have considered Hawkeye Community College for your OTA education. The application packetincludes all the information you will need to apply to the program. Please feel free to contact us for further informationin regard to the OTA program.Sincerely,Cindy KoehnCindy Koehn, OTR/LOTA Fieldwork Coordination/[email protected]

Occupational Therapy Assistant ProgramApplication Process1. Apply for admission to Hawkeye Community College (HCC). The HCC application for admission should becompleted online at /default.aspx . Thisinformation can also be accessed from the ADMISSIONS tab on the top of the HCC website homepage. Aletter of acceptance or non-acceptance will be sent by email you of your status once you have completedthe application. If you are not accepted into the new cohort, you must resubmit the application form to keepyour file active which includes your observation hours and update the immunization and physical documents.Failure to do so will result in being removed from the candidate list. The application must be resubmitted onan annual basis. This is due by December 1.2. Arrange for official transcripts (high school transcripts, GED, and any college transcripts) to be sent to theHCC Admissions Office at the following address:Hawkeye Community CollegeAdmissions Office1501 East Orange RoadP.O. Box 8015Waterloo, IA 50704-80153. The Occupational Therapy Assistant (OTA) program is a 1 1 model. Phase I consists of the generaleducation foundational content components of the program. Phase II is the professional or “core”component. Admission to the OTA program is dependent upon successful completion the following Phase Icourses with a minimum GPA of 2.75:BIO 168 Human Anatomy and Physiology I w/lab*HSC 113Medical TerminologyENG 105Composition IPSY 111Introduction to PsychologyMAT 101 Math for Liberal ArtsCSC 110Introduction to ComputersBIO 173Human Anatomy and Physiology II w/lab*SPC 101Fundamentals in Oral CommunicationHSC 108Introduction to Health ProfessionsPSY 121Developmental PsychologyPSY 241Abnormal PsychologySOC 110Introduction to Sociology OR SOC 205 Diversity in AmericaStudents may apply for admission to the OTA program while in the process of completing the Phase Icourses. *Students must have a grade of B or higher.

Applying to the OTA Program1. Application is Due by December 12. OTA program application packets are available online. The application packets will be processed when acompleted packet has been turned into the OTA office.3. Obtain an OTA application packet. The packet can be acquired in the following ways:A. Download from - .B. Stop by the OTA program office.4. Applicants will be required to submit credentials (transcripts and test scores) as required by the program’sadmission requirements.5. Complete and submit required forms:A. Student ApplicationB. A copy of college diplomas, if applicableC. A copy of your transcriptsD. Curriculum Checklist – fill out the checklist by identifying the course you have taken and the gradeyou received in each course. If you will be taking any of the prerequisite courses during the summer,please list the course section you will be attending. If you are taking summer courses at a locationother than HCC, have official transcripts resubmitted once that grade is posted.E. Observation Form - Provide documented evidence of 8 hours of observation time with a licensedoccupational therapist or certified occupational therapy assistant at 3 different facilities, for a total of24 hours. Observations must include at least two different types of facilities (example: outpatient,inpatient, home health, long-term care).F. Immunization Form from your doctor officeG. Student Health and Immunization RecordH. Iowa Core Performance Standards AcknowledgementI. Completed resume.6. Schedule a meeting with the Program Director or Academic Fieldwork Coordinator.7. Completed applicant files will be processed as follows:A. Applicants who do not meet the program’s admission requirements will be inactivated. A newapplication will need to be completed.B. Applicants enrolled in coursework to complete the admissions requirements will be candidates.C. Applicants who meet the OTA program’s admission requirements will be accepted for admission intophase II of the program however if the number of accepted applicants is over 20, the student will beplaced on a waiting list. No exceptions will be made.D. Applicants who meet the OTA program’s admission criteria will receive an email notifying them ofacceptance or conditional acceptance into the program.E. Applicants must complete all conditional acceptance criteria or they will not be a candidate for theupcoming summer cohort.8. The program will accept up to 20 students for each summer to begin Phase II.9. Upon being offered acceptance to begin the phase II of the OTA program, if the applicant chooses to declinetheir acceptance, their file is inactivated and they will need to re-apply for the program when interested.

10. Students must achieve a minimum “C” grade in all courses required to continue and to complete the PhaseII portion of the OTA program.11. Students who are not accepted into the summer phase II cohort, must submit a new application form (seethe following page) to be reconsidered for the acceptance into the next cohort by December 1. This allowsthe program to have the most recent information on file and that you are still interested in the phase II ofthe OTA program. You will not have to resubmit a new observation form.*Changes are taking place within healthcare facilities nationally.These changes directly affect all health programs atHawkeye Community College. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), whichaccredits healthcare facilities across the country, enforced background screening September 2004 and has setrequirements mandating that students in a healthcare field must now complete the same background check ashospital employees. As a Health student of Hawkeye Community College you will be required to complete a criminalbackground check, Medicare/Medicaid fraud, sex offender, urinalysis, child abuse and dependent adult registry. Theoutcome could possibly affect your opportunities to participate in the clinical setting.Hawkeye Community College does not discriminate on the basis of sex, race, age, color, creed, national origin,religion, disability, sexual orientation, gender identity, or genetic information in its educational programs,activities, admission procedures, or employment practices. Students, prospective students, employees, orapplicants for employment alleging a violation of equity regulations shall have the right to file a formal complaint.Inquiries concerning application of this statement should be addressed to: Equity Coordinator, Human ResourceServices, Hawkeye Community College, 1501 East Orange Road, P.O. Box 8015, Waterloo, Iowa 50704-8015,telephone 319-296-4405.

Occupational Therapy Assistant Program Application* Required information. This form may be filled out on the computer or use of black pen and information must be printed clearly.Personal Information*Name: (First)(M.I.)(Last)*List any degrees you have completed to this date:Name(s) that appear on previous educational records if different from above.Name: (First)(M.I.)(Last)*Mailing Address: StreetPO Box or Apt #CityIs this your permanent address? YesZip Code:No (if no please supply your permanent address below)*Mailing Address: StreetPO Box or Apt #CityZip Code:*Primary Phone: ()*Home E-mail:*Hawkeye E-mail:Alternate Phone: ()If your contact information changes, please notify the program office immediately.*Semester you desire to start Phase 2 of the OTA program: Fall of (year)Submission of this application signifies that you have completed the prerequisites and the appropriate records are on file with theHawkeye Community College (HCC) Admission Office: high school and/or college transcripts and a HCC application. The programwill verify that the prerequisites have been met. With the exception of the completion of general education courses, anyprerequisite found to be incomplete will cause the application to be returned to you. Your file completion date will be the date acompleted admissions packet, including required forms, is received by the program office (all prerequisites met).The file completion date is used to determine entry to the program if there are more than 20 students who have completed all thecriteria (prerequisites and observations). Once a class of 20 is filled, a waiting list will be maintained based on the file completiondate. Students are encouraged to complete the program application process early. Final acceptance into Phase 2 will depend uponthe successful completion of the Phase 1 course work and passing the required background checks.Upon acceptance to Phase 2 of the OTA program, the student will complete the Criminal Background check waiver for OccupationalTherapy Assistant students. This form can be found in the OTA Student Handbook students receive following acceptance into theprogram.Student Signature:Date Application Received:File Completion Date:Date:Staff Initials:

Occupational Therapy Assistant Program – Curriculum Checklist for Program PrerequisitesName:FIRST YEAR SEMESTER IBIO 168 HumanAnatomy andPhysiology I w/Lab*CSC 110 Introductionto ComputersENG 105 CompositionIHSC 113 MedicalTerminology forHealth SciencesMAT 110 Math forLiberal ArtsPSY 111 Introductionto PsychologyTotalFIRST YEAR – SEMESTER IICREDITSHCC Student ID:LETTER GRADEGRADE OF COURSESTRANSFERREDGRADE POINTSLETTER GRADEGRADE OF COURSESTRANSFERREDGRADE POINTS43323318CREDITSBIO 173 Human Anatomy4and Physiology II w/Lab *HSC 113 Introduction to2Health ProfessionsPSY 121 Developmental3PsychPSY 241 Abnormal3PsychologySOC 110 Introduction to3Sociology or SOC205Diversity in AmericaSPC 101 Fundamentals of3Oral CommunicationTotal18 Students need to have a “B” or higher grade to process application.Students may complete Phase I course work any time prior to entering Phase II, with the exception ofHuman Anatomy and Physiology, which must be taken within five years of entry into Phase II, unlesswaved by the program director. Transfer students must have an official copy of their transcripts sent tothe Admissions Office for approval of general education courses.The minimum cumulative GPA for Phase I courses is 2.75. Students must receive a grade of at least 2.0(“C”) or better on a 4.0 scale for all Phase I courses, with the exception of BIO 168Human Anatomy andPhysiology I w/Lab and BIO 173Human Anatomy and Physiology II w/Lab .

Occupational Therapy Assistant ProgramHawkeye Community CollegePre-admission Observation HoursStudent Name (printed):The individual who has asked to observe at your facility is interested in applying to the OTA program atHawkeye Community College. This observation is part of the admission requirements. Through thisexperience, we anticipate that the applicant will gain first hand exposure to occupational therapy in order todetermine a correct career choice. We ask that they observe a registered occupational therapist (OTR) orcertified occupational therapy assistant (COTA) for 8 hours of direct patient care in 3 different clinical settings(example: outpatient, inpatient, home health, long-term care, etc.). Observations must include at least twodifferent facilities. The 8-hour observation can be completed in one or more visits, depending on your facility’spreference. Observations will not be accepted from your current employer. Please complete the informationbelow to document that the student has completed the observation requirement. Thank you for yourassistance with this process. If you have any questions or concerns please feel free to contact theOccupational Therapy Assistant Program Director or Academic Fieldwork Coordinator.*Students are responsible to arrange observation hours and adhere to all facilityprofessional dress code, policies and procedures.*Completed observation forms and observation log must to be returned to the Occupational TherapyAssistant program with a student’s completed application packet and current resume.**Your supervisor has the right to send you homeor refuse the observation, if you are not properlydressed, demonstrating unaccepted professionalbehavior, etc.

Observation 1:Facility Name:Facility Type: Acute IPDateOP ClinicTimeCity:Home Health Nursing Home Rehab Center Other:FacilitySignature of SupervisorI verify that I am a registered occupational therapist or certified occupational therapy assistant and the abovenamed individual observed with me for a total of 8-hours.Clinician Name:License #Clinician Signature:Date:Observation 2:Facility Name:Facility Type: Acute IPDateOP ClinicTimeCity:Home Health Nursing Home Rehab Center Other:FacilitySignature of SupervisorI verify that I am a registered occupational therapist or certified occupational therapy assistant and the abovenamed individual observed with me for a total of 8-hours.Clinician Name:License #Clinician Signature:Date:

Observation 3:Facility Name:Facility Type: Acute IPDateOP ClinicTimeCity:Home Health Nursing Home Rehab Center Other:FacilitySignature of SupervisorI verify that I am a registered occupational therapist or certified occupational therapy assistant and the abovenamed individual observed with me for a total of 8-hours.Clinician Name:License #Clinician Signature:Date:My signature certifies that the above information is accurate. Hours listed with current employer will not beaccepted and need to observe in a minimum of 2 different settings. I understand that if I have falsified theinformation, I will be denied eligibility to continue the application process of the OTA Program. The hoursmust be equivalent to a total of 24 hours.Signature of StudentDate

Iowa Core Performance Standards for Health Care Career Programs:Iowa Community Colleges have developed the following Core Performance Standards for all applicants to Health CareCareer Programs. These standards are based upon required abilities that are compatible with effective performance inhealthcare careers. Applicants unable to meet the Core Performance Standards are responsible for discussing thepossibility of reasonable accommodations with Hawkeye Community College Students Disability Services Office. Beforefinal admission into a health career program, applicants are responsible for providing medical and otherdocumentation related to any disability and the appropriate accommodations needed to meet the CorePerformance Standards. The student must meet with the Students Disability Services Office to complete theprocess for the necessary ardSome Examples of Necessary Activities (not all inclusive)The ability to perceive eventsrealistically, to think clearly andrationally, and to functionappropriately in routine andstressful situations.Critical thinking ability sufficient forsound clinical judgment. Identify changes in patient/client health status Handle multiple priorities in stressful situationsInterpersonal abilities sufficient tointeract appropriately withindividuals, families, and groupsfrom a variety of social, emotional,cultural and intellectualbackgrounds.Communication abilities in Englishsufficient for appropriateinteraction with others in verbaland written form.Ambulatory capability tosufficiently maintain a center ofgravity when met with anopposing force as in lifting,supporting, and/or transferring apatient/client.Auditory ability sufficient tomonitor and assess, or documenthealth needs.Visual ability sufficient forobservation and assessmentnecessary in patient/client care,accurate color discrimination.Tactile ability sufficient forphysical assessment, inclusive ofsize, shape, temperature, andtexture.The ability to tolerate lengthyperiods of physical activity.Ability to tolerate environmentalstressors. Identify cause/effect relationships in clinicalsituations Develop plans of care Establish rapport with patients/clients andcolleagues Demonstrate high degree of patience Manage a variety of patient/client expressions(anger, fear, hostility) in a calm manner Read, understand, write, and speak Englishcompetently Explain treatment procedures Initiate health teaching Document patient/client responses Validate responses/messages with others The ability to propel wheelchairs, stretchers, etc.,alone or with assistance as available Hears monitor alarms, emergency signals,ausculatory sounds, cries for help Hears telephone interactions/directions Observes patient/client responses Discriminates color changes Accurately reads measurement on patient/clientrelated equipment Performs palpation Performs functions of physical examinationand/or those related to therapeutic intervention,e.g. insertion of a catheter Move quickly and/or continuously Tolerate long periods of standing and/or sitting Adapt to rotating shifts Work with chemicals and detergents Tolerate exposure to fumes and odors Work in areas that are close and crowded Work in areas of potential physical violence

Occupational Therapy Assistant ApplicationIowa Core Performance Standards for Health Care Career ProgramsAcknowledgement FormPlease sign and return this portion of the document with the other required applicationpacket forms.My signature acknowledges that I have been provided with the document “Iowa Core PerformanceStandards for Health Care Career Programs” and am familiar with its content. I understand that I mayrequest reasonable accommodations in order to meet these standards.Name (please print):Signature: Date:

*Please make a copies of the original completedphysical and immunization forms. Clinical sitesmay request a copy of this information and it isyour responsibility to provide those copies. Theprogram will not provide copies of your physicaland immunization record.

3. The Occupational Therapy Assistant (OTA) program is a 1 1 model. Phase I consists of the general education foundational content components of the program. Phase II is the professional or “core” component. Admission to the OTA program is dependent upon successful completion the following Phase I courses with a minimum GPA of 2.75: