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Louisiana occupational therapy association occupational therapy course approval request


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OFFICIAL USE ONLY:

Reviewer’s Signature: _____________________

Not Approved: _____________________

Approved: _____________________





LOUISIANA OCCUPATIONAL THERAPY ASSOCIATION

OCCUPATIONAL THERAPY COURSE APPROVAL REQUEST

(Home-Study Courses Excluded)


  1. Course Title: ­­

     

  1. Date(s) and hours of instructions NOT including lunch or breaks:

     

  1. Location(s):

     

  1. Sponsoring Organization:      

Name, Address, Phone Number and Email for Contact Person:      

  1. Course Instructor:      

  2. Course Instructor background information:

(i.e. education, employment, publication and instruction experience, attach CV.)

     

  1. Specifically, how will monitoring of course participation and completion be handled?

     


  1. Course content/outline (may attach):

     

  1. Course objectives and goals (may attach):

     

  1. Indicate if this continuing education activity has been approved for credit by any other professional organizations or licensing boards:

     

  1. Attach a copy of all handouts or written course materials along with an outline of visual aids to be utilized.




  1. Enclose a NON REFUNDABLE $30.00 per course processing fee.

Make check payable to: Louisiana Occupational Therapy Association or LOTA.

Allow not less than 60 days for request to be processed.



  1. Enclose a self-addressed and stamped envelope so that a reply may be sent to you.

  2. Mail this form and payment to:

CONTINUING EDUCATION COURSE APPROVAL

LOUISIANA OCCUPATIONAL THERAPY ASSOCIATION

PO BOX 14806

BATON ROUGE, LA 70898




  1. If you have questions, please contact the LOTA Office at: 225-291-2806



ALL INFORMATION MUST BE COMPLETED ON THE FORM WITH THE EXCEPTION OF COURSE CONTENT, OBJECTIVES AND INSTRUCTOR BACKGROUND.

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