Occupational Therapy Benevolent Endowment
This grant's purpose is to provide benevolence to Texas occupational therapy practitioners during hardship so that they can deliver occupational therapy services.Grants are awarded based on the following needs:~ Fees for obtaining and renewing the TBOTE license~ Financial support for continuing education registration and/or travel~ Funding for other costs related to the delivery of occupational therapy servicesParameters of OTBE Grant funding:~Designed to support OTs and OTAs currently licensed to deliver OT services in Texas~Limited to a maximum of $500~Does not permit payment directly to the grant applicant. Funding is paid directly to the provider of services that could support your delivery of occupational therapy services.At this time, OTBE Grants are not available to OT students.
Application Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
Phone Number
TBOTE
Eligibility to deliver OT Services in Texas
OT
OTA
License Number
License Expiration Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Number of CEU's completed, if any, to support TBOTE license renewal:
Number of Years of OT Practice
Last Date of OT Employment:
Current OT Employment Status:
Full Time
Part Time
PRN
Unemployed
Medical Leave
Disabled
Current Employer Contact Information (if applicable):
Facility Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Immediate Supervisor
Email
Phone Number
Current Professional Organizational Engagement
TOTA Member #
AOTA Member #
Professional Credentials (including specialty certifications)
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Significant Life Crisis Event(s)
Natural Disaster
Health Crisis
Immediate Family Crisis
Other
Briefly describe how your ability to deliver OT services in Texas is most impacted by your significant life crisis event.
Identify any resources you've already personally accessed or attempted to access.
Briefly describe your plan to return to OT practice. Include a timeline for achieving your goal.
OTBE Grant Funding Requests
Identify all of the OT OTBE Grant funding areas you believe can best support your ability to deliver OT services in Texas, including the dollars you anticipate will be needed to achieve your goal.
Funds to support CEUs needed to renew OT License:
Funds to support renewal of OT License:
Funds to reinstate your Texas OT License:
Funds to support License renewal eligibility (fingerprinting):
Funds to support License renewal eligibility (late fees):
Funds to support TOTA or AOTA membership to gain access to CEUs and OT community engagement:
Other (identify other potential areas of funding):
Other Information
Please include any other information you would like the OTBE Grant Committee to consider when renewing your OTBE Grant Application.
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Professional Reference 1
Name
First Name
Last Name
Email
Phone Number
Professional Reference 2
Name
First Name
Last Name
Email
Phone Number
Submit
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