Graduate Program Directors
If you are a Director of Clinical Education for a graduate program looking to set up a clinical rotation for your students, please fill out the form below to connect with our Quality Control Manager. We welcome the opportunity to collaborate and support your program’s educational goals.
Name
*
First Name
Last Name
Title
*
University/College Name
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Program Type:
*
Occupational Therapy (OT)
Physical Therapy (PT)
Speech-Language Pathology (ST)
Other
Student's Name(s) (if applicable):
Type of Placement Requested:
*
Level I Fieldwork
Level II Fieldwork
Clinical Internship
Other
Preferred Start Date
*
-
Month
-
Day
Year
Date
Preferred End Date
*
-
Month
-
Day
Year
Date
Desired Weekly Schedule (Days/Hours):
*
Are there specific learning objectives or requirements for this placement?
*
Are there any particular diagnoses, populations, or specialty areas of interest?
*
Is this student interested in pediatric, adult, or a mixed caseload?
*
Pediatric
Adult
Mixed
No Preference
Does the student require a specific number of hours to complete this placement?
*
Is there a specific therapist or clinical experience required?
*
Are there any additional details or considerations we should be aware of?
Submit
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