Occupational Therapy Assistant Program Application

Occupational Therapy Assistant Program Application

Complete this application online and hit submit once completed. This application and all required documentation must be submitted online by 5:00 p.m. CST, Friday, May 15, 2026. If you have any questions regarding the application please contact Yvette Royal at 903-694-4026.
Notice: Be sure that your prepared essay is ready to upload before filling out the application, as there is no save option. Essay Instructions: Attach a 400 – 600 word, typed, double-spaced essay explaining why you want to become a COTA. The essay must be uploaded in a .pdf format.*

.pdf format only
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Date*

MonthDayYear
Date
Panola College Student ID*
Date of Birth*

MonthDayYear
Date
Full Name*

First NameMiddle NameLast Name
Other Names Used:
List all Names you may have used in the past.
Cell Phone Number*

Area CodePhone Number
Home Phone Number*

Area CodePhone Number
Personal Email*

Confirmation EmailConfirm Email
Panola College Email*

Confirmation EmailConfirm Email
Mailing Address*

Street Address

County or Parish

CityState

Zip Code
Select which county residency is in:*
If other is selected above please enter the county you live in.
Name of County
Physical Address (if different than above)

Street Address

County or Parish

CityState / Province

Postal / Zip Code
Emergency Contact:

First NameLast NameContact Number
Emergency Contact:

First NameLast NameContact Number
Applicants must be fully accepted to Panola College and ALL official transcripts MUST be submitted to the Admissions Department before this application will be processed.
Have you applied and been accepted to Panola College?*
Have you previously applied to the Panola College OTA program?*
When?
Which other Health Science programs have you applied to or attended? *
N/A if not applicable
Name of School you applied to?*
N/A if not applicable
Name of the program?*
N/A if not applicable
Dates Attended (if accepted):*
N/A if not applicable
If program wasn't completed, why?*
N/A if not applicable
A letter of good academic standing from all previous allied health programs is required if the program was not completed.
Provide information concerning high school graduation or G.E.D.
Name of school:*
City and State*
Date of graduation?*
GED date (if applicable)
Provide information concerning ALL college, university, vocational schools, and allied health schools attended and the number of credits earned, including any taken at Panola College. Example: 1. Panola College - Carthage, TX - 20 credits*
Degree - Please check highest degree received*

No college degreeAssociates DegreeBachelors DegreeMasters Degree
Need to know information: List any information that we may need to know regarding your application. Example: In progress of a pre-requisite course, the college your attending semester ends on or after the application deadline, not being able to complete a pre-requisite course during the application period due to an illness or extenuating circumstance......
List any licenses or certificates you may hold. Include all license/certification numbers and state regulatory body issuing the license/certificate. Do not include drivers license.*
N/A if Not Applicable
Provide information concerning last two (2) employers: (List most recent job first ).
Employer & Address:
Dates Employed & Position Held:
Employer & Address:
Dates Employed & Position Held:
How do you plan to meet the expenses of this program? (Check all that apply).*

GrantLoanScholarshipFull-time jobPart-time jobFamily SupportGovernment AgencyOther
Scholarship Opportunities for Panola College OTA Applicants/Students

The OTA Program strongly encourages all students to apply for scholarships at Panola College to decrease student financial burden. Please click here for resources and scholarship opportunities available at Panola College.
If you selected Grant, Loan or Scholarship above, have you already applied for financial aid at Panola College?
How did you find out about the Panola College OTA program?

High school counselor/instructorCollege Counselor/InstructorClassmate/friendRelativeCo-WorkersCareer FairInternet8th grade event at Panola CollegeOther
Read each statement below, initial and sign that you have read and understand each statement.
The program for which you are applying may require extended travel for fieldwork assignments in the early morning, late evening and/or weekends. Are you prepared to meet this requirement?*
I understand that if I have been charged or convicted of a felony offense, I might not be eligible for OTA licensure in Texas and/or certification by the National Board for Certification in Occupational Therapy. I also understand that if I have a criminal history, I'm not guaranteed a fieldwork placement. Initials*
If any professional licensing or disciplinary body in any state, territory, foreign jurisdiction or nation denied, limited, restricted, suspended, canceled, or revoked any professional license, certificate or registration granted to you, or imposed a fine or reprimand, or has taken any other disciplinary action against you, it is advised you schedule a meeting with the Chair of the OTA Program to discuss your potential restriction for certification or licensure after completing the OTA Program. Initials*
If you ever voluntarily surrendered any credentials in anticipation of an investigation or disciplinary proceeding or entered into a consent agreement with respect to licensure, it is advised you schedule a meeting with the Chair of the OTA Program to discuss your potential restriction for certification or licensure after completing the OTA Program. Initials*
If you have ever been arrested anywhere, regardless of the outcome or reason for the arrest, including arrests with pending charges or result in deferred adjudication, deferred status, dismissal, being sealed or expunged, with or without a finding of guilt, it is advised you schedule a meeting with the Chair of the OTA Program to discuss your potential restriction for certification or licensure after completing the OTA Program. Initials*
Important Information: Interviews will be held on Friday, June 12, 2026, from 8:30 a.m. to 5:00 p.m. for eligible applicants. Applicants will be notified via email by Tuesday, June 2, 2026, if they will have an interview on Friday, June 12, 2026. Initial here to confirm your understanding. Initials
I hereby certify that the information contained in this application is true and complete to the best of my knowledge. I understand that any misrepresentation of falsification of information on this or any part of the application process is cause for denial of admission or expulsion from the Occupational Therapy Assistant Program.*

Clear
Panola College is an Equal Opportunity Institution that provides educational and employment opportunities on the basis of merit and without discrimination because of race, color, religion, sex, age, national origin, veteran status, disability or genetic information.
Panola College OTA Program

Essential Functions/Requirements for OT Service Delivery

The following are essential job functions required by Occupational Therapy Assistant Students and by

Occupational Therapy Assistants in the workforce. Each student must be able to perform all of the following skills and possess the following abilities.

Qualified persons with a disability who can perform all of the listed essential functions with reasonable accommodations will not be denied admission into the OTA program. However, a college advisor must be contacted in order to best determine the reasonable accommodations necessary for successful completion of the OTA program. Fieldwork placements are not guaranteed and may require extra time for completion.

Communication Skills:

The OTA student should possess communication skills sufficient for effective interaction with clients, caregivers and other professionals in verbal and written form.    Specifically, the student must be able to effectively report and document clinical observations, provide client and caregiver instruction, gather data through interviewing, participate in team meetings and provide in-service presentations.

Interpersonal skills:

The OTA student should possess interpersonal and self-management skills sufficient to interact with individuals, families and groups from a variety of social, emotional, cultural and intellectual backgrounds. For example, the student must be able to establish therapeutic relationships with patients, families and significant others. The student must be able to effectively participate as a member of a team.

Mental Functions:

The OTA student must possess critical thinking skills sufficient for clinical judgment. Specifically, the student must be able to use the PEO model as a basis for solving client problems. This involves identifying cause and effect relationships in clinical situations, developing appropriate interventions, and safely and effectively providing treatment. The student must be able to use sound judgment and apply safety measures in a variety of clinical situations.   The student must be able to analyze and interpret intervention goals and other resources for use in clinical decision making. The student must be able to organize and effectively manage time to meet deadlines and perform neat and accurate work.

Mobility:

The OTA student should possess physical skills sufficient to maneuver throughout classrooms, labs and fieldwork facilities and within small spaces to provide effective intervention. Specifically, the student must be able to move around in patient rooms, bathrooms, classrooms, clinics and home environments (including steps) to provide effective treatment implementation.   The student must be able to travel to fieldwork sites as assigned.

Motor Skills:

The OTA student should possess gross and fine motor skills sufficient to function as an OTA. Specifically, the student must be able to use equipment, fabricate and use adapted devices, fabricate splints and utilize fine motor activities in client treatment as required in classroom, lab and fieldwork activities. The student must also be able to position, transfer and transport clients, provide physical assistance to patients as needed and demonstrate physical endurance adequate for general OT service delivery.

Hearing:

The OTA student should possess auditory skills sufficient to monitor and assess client needs. Specifically, the student must be able to gather data via interview, hear monitor alarms, emergency signals, auscultatory sounds (breath and heart sounds) and cries for assistance.

Visual:

The OTA student should possess visual skills sufficient for observation, assessment and interventions required for OT service delivery. Specifically, the student must be able to recognize a change in the patient’s physical condition, read assessment instruments and develop, implement and monitor the patient’s response to a variety of OT interventions.

Tactile:

The OTA student should possess tactile skills to effectively deliver OT services. Specifically, the student must be able to palpate muscle contractions, effectively provide varying amounts of physical resistance for muscle group testing, and/or functions related to therapeutic intervention.

I verify that I have read and fully understand the Essential Functions/Requirements for OT Service Delivery. I also understand that if I have a disability requiring accommodation in any of the above skill areas, that it is my responsibility to contact a college advisor before beginning the program, to determine whether a suitable accommodation can be made that would enable me to effectively provide OT services.
Name*
Date*
Signature*

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Occupational Therapy Assistant Program Application

Applicants must be fully accepted to Panola College and ALL official transcripts MUST be submitted to the Admissions Department before this application will be processed.

A letter of good academic standing from all previous allied health programs is required if the program was not completed.

Provide information concerning high school graduation or G.E.D.

Provide information concerning last two (2) employers: (List most recent job first ).

Read each statement below, initial and sign that you have read and understand each statement.

Panola College is an Equal Opportunity Institution that provides educational and employment opportunities on the basis of merit and without discrimination because of race, color, religion, sex, age, national origin, veteran status, disability or genetic information.