M
aster of Occupational Therapy
MOT Application Cover Page
Last Name: ___________________________ First Name: __________________________
Muskingum ID # _______________________
Address 1: _____________________________________________________________________
Address 2: _____________________________________________________________________
City: _________________________________ State: _______ Zip: ______________
Cell Phone Number: _____________________________________________________________
If no cell phone, reliable phone for contact: __________________________________________
Email Address: _________________________________________________________________
OTA Institution: ___________________________________ Grad Year: ______________
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Master of Occupational Therapy Program
Application to the Master of Occupational Therapy Program
Please note: This application assumes that you have either already completed all of the prerequisite courses required
for admission to the MOT or are on a plan that will result in all courses being completed prior to starting the program. If
you are uncertain about this or have questions, please contact Jan Winland at jwinland@muskingum.edu
or
740.826.6151.
Other
wise, let’s get started.
To b
egin the MOT application process, you will need to:
1. Apply
By completing the 3-step Application Criteria and Documentation Checklist (below). Because you earn admission
points through this process, please take care to complete each step thoroughly and as instructed. If you have
questions, please contact Program Director Dr. Mary Arnold at 740-826-8466 or at marnold@muskingum.edu.
2. Request recommendations
By arranging the submission of 2 Recommendation Assessment forms: one from your supervising OTR, and one
from a community professional.
3. Submit answers to questions on the Written Interview form.
As part
of the MOT application process, applicants who receive high scores may be invited to participate in an oral (face-
to-face or Skype) interview with the MOT program director or her designees prior to a final decision about admission to
the MOT program.
The M
OT program at Muskingum welcomes applications at any time, however, to be fully considered for acceptance
into a fall cohort, please complete your application file by February 15.
Rem
ember, too, if you have any questions along the way, assistance is available by contacting Program Director Dr.
Mary Arnold at marnold@muskingum.edu
or 740-826-8466.
Now,
get started and good luck!
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Master of Occupational Therapy
Application Criteria and Documentation Checklist 2020
This document should come immediately after the cover page in your application folder. It both
allows you to verify that you have remembered to include everything and will be used as a
review document by the admissions team.
Your completed application documents must be submitted by February 15 to considered for
admission to the fall cohort.
Step 1 (part 1): Preliminary qualifications required for admission to the MOT
You must first meet each of the following qualifications to be considered for admission to the
MOT program. Therefore, no admission points are ascribed with any of these criteria. Listed in
parentheses () after each item are descriptors of supporting document(s) you need to submit
with your application.
Check each item that applies to you.
1) I am a credentialed OTA, initially certified by NBCOT and licensed in my state of
residence. (NBCOT certificate or document of initial certification from NBCOT and
state license look-up document or copy of pocket license ID)
2) I have or will have completed all prerequisite courses prior to the start of MOT
classes. I understand that each prerequisite course must have been completed with
aC” or better grade. (Copy of transcripts from all institutions with prerequisite
courses highlighted)
3) I have completed a minimum of 90 semester hours or equivalent of undergraduate
coursework credit (transcripts cited above)
4) I have worked as an OTA for the equivalent of one year of full-time (1500 hours)
employment within the most recent 60 months. (A document from employer(s)
identifying timeframe and number of hours worked.)
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Step 1 (part 2): Scored Qualifications: The MOT program will complete scoring.
Applicant please check items as verification that you have submitted required items
Each of the qualifications below is worth a maximum of 100 points for a combined total of 300
points. These items, therefore, each represent one-third of the total points in the required
written (paper) portion of your application.
5) A minimum GPA of 2.75 on a 4.0 scale.
We will use the transcripts you submit to calculate your GPA using your GPA from
your OTA education and averaging it with the GPA for all prerequisite courses,
regardless of where they were taken. In the event that prerequisite courses were
part of courses within the OTA program, those courses will count in both
calculations. Scoring: The average GPA will be multiplied by 25 and the total
reported as the score for this item.
6) Two recommendation assessments.
Each assessment will be worth a maximum of 100 points. Your score will be the
average of the two assessment scores. Remember that we ask that the assessments
be completed by 1) one of your supervising OTRs from the past 36 months, 2) a
community professional (ex: supervisor, volunteer leader, clergy member)
7) A Written Interview.
Please submit responses to the 5 questions presented, each worth a maximum of 20
points.
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Step 2: Bonus Points: Applicant please check items for which you are providing proof
Believing that the following experiences would serve to make a more skilled and well-rounded
applicant and might enhance the ability to engage and be successful in the MOT program, you
can earn a small number of extra points by documenting all or some of the following
experiences.
While these items are NOT REQUIRED for admission to the MOT program, the additional points
you may earn through this process will be considered in the admission decision.
I have earned a bachelor’s degree (transcripts)
1.5 points for a bachelor’s degree in any subject
2 points for a bachelor’s degree in Occupational Science
I serve/have served in an organizational leadership role (please provide documentation of
appointment or election, documents that show work done while in the role, or a letter on
agency letterhead and signed by a representative that outlines your leadership role and
accomplishments)
1 point for a leadership role in the department in which you work
1 point for a leadership role within the company for which you work
1 point for a leadership role in a non-OT agency or organization
2 points for a leadership role within an OT agency/organization
I have volunteered service to the community in non-leader roles during the past 12 months
(documentation from community organization indicating the timeframe and number of hours
you volunteered for their agency)
1 point for 1-25 hours
2 points for 26-60 hours
3 points for over 61-90 hours
4 points for over 90 hours
I have been a member of a professional association for a minimum of 1 year prior to
application (documentation from the professional association)
.5 point for state association membership 2 years or less
1 point for state association membership more than 2 years
.5 points for AOTA membership 2 years or less
1 point for AOTA membership 3-5 years
1.5 points for AOTA membership 6-10 years
2 points for AOTA membership over 10 years
5
I have completed more than the minimum 20 hours of continuing education in the past 24
months.
.5 point for 21-25 hours
1 point for 26-30 hours
1.5 points for 31 or more hours
Step III: Oral Interview (either face-to-face or via teleconference)
Candidates may be asked to submit to an oral interview. Oral interviews will be conducted at
the discretion of the MOT program director by invitation only. Should such an interview be
required, you will be notified by the MOT program director.
Interviews will be conducted by ad hoc committees assembled at the invitation of the MOT
program director.
Additional details about the oral interview process will provided if you are invited to participate
in such an interview.
6
Master of Occupational Therapy
APPLICATION FOR ADMISSION
Muskingum University
Graduate & Continuing Studies
10 College Drive, New Concord, OH 43762-1837
PH: 740-826-8038 FAX: 740-826-6038
www.muskingum.edu gcs@muskingum.edu
ABOUT YOU
Last Name:
First Name:
MI:
ID#:
Address:
City:
State:
Zip:
Phone:
Email:
Employer:
Title:
Have you ever been convicted of a felony?
Yes
No
How would you describe yourself? (Please check all that apply, if multi-racial, provide percentage for each category checked.)
Gender
Ethnicity
Race
Female
Hispanic/Latino
American or Alaskan Native
%
Asian
%
Male
Non-Hispanic/Latino
Black or African-American
%
White
%
Hawaiian or Pacific Islander
%
OTA TRANSCRIPT INFORMATION (Please list college or university where you earned your OTA)
Name of College/University
City and State
Degree Earned
Date Earned
GPA
OTHER COLLEGE/UNIVERSITY TRANSCRIPT INFORMATION
(Please list colleges or universities you’ve attended)
Name of College/University
City and State
Degree Earned
Date Earned
GPA
(Please complete the reverse side of this form)
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HAVE YOU SUBMITTED/CCOMPLETED THE FOLLOWING REQUIRED APPLICATION MATERIALS?
Official transcripts from all previous colleges and/or universities
Three (3) recommendation assessments
Written interview questions
Completion of all pre-requisite courses
Would you like information about financial aid?
Yes
No
Don’t Know
How did you become interested in Muskingum University Graduate and Continuing Studies?
Referred by friend
Website
Google Search
Social Media
OT Conference
Other:
I c
ertify that the information provided on this application is complete and correct to the best of my knowledge. I understand that I am responsible for arranging
for the forwarding of official transcripts from schools I have attended, and that such transcripts become the property of Muskingum University and will not be
returned.
Signature
Date
Availability of Student Records: Muskingum University abides by the Family Educational Rights and Privacy Act of 1974 as amended. All students have access to their education records on file with the College and have
the right to challenge records they feel are inaccurate. Further information is available from the Registrar’s Office.
Sources of Consumer Information: Graduate academic programs and policies (including costs, fees, refunds, financial aid and accreditation) are described in the Graduate Catalog. Additional information about
graduate programs is available from the Office of Graduate and Continuing Studies, and from program directors. Muskingum University, as an educational institution, does not discriminate on the basis of race,
color, religion, sex, national or ethnic origin, handicap, physical challenge, disability, sexual orientation, socio-economic status and political affiliation.
Muskingum University Annual Crime Statistics Disclosure: This report includes statistics for the previous three years concerning reported crimes that occurred on campus; in certain off-campus buildings or
property owned or controlled by Muskingum University; and on public property within, or immediately adjacent to and accessible from, the campus. The report also includes institutional policies concerning campus
security, such as policies concerning alcohol and drug use, crime prevention, the reporting of crimes, sexual assault, and other matters. You can obtain a copy of this report by contacting Campus Police or by
accessing the following website: http://www.ope.ed.gov/security/index.aspx.
Questions? Call 740-826-8038.
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click to sign
signature
click to edit
Master of Occupational Therapy Program
Recommendation Assessment Instructions and Form
The student named below is applying for admission to the Master of Occupational Therapy Program at Muskingum
University. Students applying to this program are required to have recommendation assessments from 1) their
supervising OTR, 2) a faculty member from their OTA Program (or if not available an instructor for one of their
occupational science courses) and 3) a community professional. This student has requested that you act as his/her
professional reference. Please complete this form beginning on page 2 as thoroughly as possible and return the form to
the Occupational Therapy Program at the address provided. Seal the form in the envelope and sign the flap of the
envelope across the seal. Mail the document to the MOT Program Director: Mary M. Arnold OTD, OTR/L FAOTA,
Muskingum University, 10 College Drive, MH 117, New Concord, Ohio 43762-1837
T
he purpose of this reference form is to gain information on skills and abilities desirable for students planning a career in
occupational therapy at the professional level. Information from this reference will be one of several factors used in
determining the student’s qualifications for the Master of Occupational Therapy Program.
I. APPLICANT INFORMATIONto be completed by the applicant
Potential Student’s Name:
Address:
City:
State:
Zip:
Phone:
Email:
I do
do not
waive my rights to review this reference form at some future time
Signature:
Date:
I
am requesting that the following person complete a recommendation assessment on my behalf:
Reference Name (Please print):
Title:
Company/Agency:
Address:
City:
State:
Zip:
Phone:
Email:
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Recommendation Assessment
Please circle a rating for each item below. Not Applicable (N/A) or don’t know do not count against the applicant
however we request an explanation (on back) as to why the item is N/A or don’t know for the applicant or facility.
Scoring Guide
The applicant meets the requirement:
5 = a minimum of 95% of the time 3 = a minimum of 80% of the time 1 = less than 75% of the time
4 = at least 90% of the time 2 = at least 75 % of the time
Ap
plicant’s Name:
Professional Behaviors Does the applicant exhibit:
Positive Attitude and flexibility
Fosters helpful communication
5
4
3
2
1
N/A or don’t know
Ability to adapt to change
5
4
3
2
1
N/A or don’t know
Managing stressors
5
4
3
2
1
N/A or don’t know
Pleasant demeanor
5
4
3
2
1
N/A or don’t know
Professional Communication Skills
Uses proper grammar
5
4
3
2
1
N/A or don’t know
Monitors and appropriately uses nonverbal communication
5
4
3
2
1
N/A or don’t know
Handles conflict constructively
5
4
3
2
1
N/A or don’t know
Uses assertive communication when necessary
5
4
3
2
1
N/A or don’t know
Teamwork
Knows and tries to achieve team goals
5
4
3
2
1
N/A or don’t know
Anticipates the needs of others
5
4
3
2
1
N/A or don’t know
Works well in groups
5
4
3
2
1
N/A or don’t know
Shares or pools resources
5
4
3
2
1
N/A or don’t know
Keeps others informed
5
4
3
2
1
N/A or don’t know
Respects diversity
5
4
3
2
1
N/A or don’t know
Personal Responsibility
Seeks out learning opportunities
5
4
3
2
1
N/A or don’t know
Is aware of strengths and weaknesses
5
4
3
2
1
N/A or don’t know
Volunteers for additional responsibilities
5
4
3
2
1
N/A or don’t know
Is punctual
5
4
3
2
1
N/A or don’t know
Demonstrates initiative
5
4
3
2
1
N/A or don’t know
Asks questions when in doubt
5
4
3
2
1
N/A or don’t know
Modifies performance after feedback
5
4
3
2
1
N/A or don’t know
Has good attendance
5
4
3
2
1
N/A or don’t know
Organization skills
Maintains neat and orderly workspace
5
4
3
2
1
N/A or don’t know
Is timely
5
4
3
2
1
N/A or don’t know
Organizes assignments and duties
5
4
3
2
1
N/A or don’t know
Signature:
Print Name:
Date:
10
Explanations/Comments:
Positive Attitude and flexibility
Fosters helpful communication
Ability to adapt to change
Managing stressors
Pleasant demeanor
Professional Communication Skills
Uses proper grammar
Monitors and appropriately uses
nonverbal communication
Handles conflict constructively
Uses assertive communication when
necessary
Teamwork
Knows and tries to achieve team
goals
Anticipates the needs of others
Works well in groups
Shares or pools resources
Keeps others informed
Respects diversity
Personal Responsibility
Seeks out learning opportunities
Is aware of strengths and weaknesses
Volunteers for additional
responsibilities
Is punctual
Demonstrates initiative
Asks questions when in doubt
Modifies performance after feedback
Has good attendance
Organization skills
Maintains neat and orderly
workspace
Is timely
Organizes assignments and duties
11
Master of Occupational Therapy Program
Written Interview Instructions and Questions
Ple
ase answer the following questions by submitting carefully written responses that are thorough and well
thought out.
Pl
ease be sure to save your document for upload into your online application once completed.
Pleas
e be sure to include the question you are answering with each response and to limit each reply to no more
than 250 words.
QU
ESTIONS:
1) What strengths will you contribute to the MOT program and fellow students, should you be accepted?
2) What are the differences between the role of OTR and OTA?
3) Within the role described in question 2, what do you most look forward to doing, and why?
4) What specific ways do you envision occupational therapy having a role in overcoming the opioid epidemic?
5) The American Occupational Therapy Association has established the following Vision for 2025:
Occupati
onal therapy maximizes health, well-being, and quality of life
for all people, populations, and communities through effective solutions
that facilitate participation in everyday living.
Wh
at leadership skills and experiences do you have that could help the profession to realize that vision?
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