Observation Form
Occupational Therapy Assistant Program
Name:
In an attempt to assure that persons applying for acceptance into the IHCC Occupational Therapist Assistant
Program possess greater awareness and understanding of the responsibilities and duties of Occupational
Therapist Assistants, each prospective student is required to have a minimum of 10 hours of exposure to the
Occupational Therapy Profession. Observation may be completed at one or more sites, in at least two dierent
practice areas, under the supervision of a licensed Occupational Therapist or Occupational Therapy Assistant.
These exposure hours may include hours spent 1). Observing a licensed occupational therapist or OT assistant
while working, 2.) Volunteering in an occupational therapy department or 3.) Being employed in an occupational
therapy facility.
Please have this form completed by the OT or COTA whom you observed.
Facility Date Hours
O = Observed
V = Volunteered
E = Employed
OT/COTA
Signature
License #