FIELDWORK RESERVATIONS

University of Central Arkansas
Department of Occupational Therapy
Level I and Level II Fieldwork Reservations

Name of Facility *

If multiple sites are available, please complete a separate form for each location.
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Facility Phone * - (###) - ### ####
Facility Web Site
Contact Person for Fieldwork Assignments * First Last
Credentials/Position *
Contact Phone * - (###) - ### ####
Contact Email *
Age Groups Served (Mark all that apply.) * 0 - 5 6 - 12 13 - 21 22 - 64 65+
Practice Setting (Mark all that apply.) * Hospital-based Community -based School-based Other
Hospital-based Setting (Mark all that apply.) Inpatient Acute Inpatient Psych Inpatient Rehab Long Term Care/ SNF Outpatient Hands Outpatient General Rehab Pediatric Hospital/Unit Pediatric Hospital Outpatient
Community-based Setting (Mark all that apply.) Adult Day Program for DD Behavioral Health Community Home Health Older Adult Community Living Older Adult Day Program Outpatient/Hand Private Practice Pediatrics Community Pediatrics Outpatient Clinic
School-based Setting (Mark all that apply.) Early Intervention School
Other Area(s), please specify.
LEVEL I FIELDWORK
LEVEL I FW-MAY
The experiential learning rotation listed below will focus on Analysis of Human Occupational Performance, including assessment and transfers, when applicable. Course objectives are available upon request.
LEVEL I Fieldwork Analysis of Human Occupational Performance
May 23- June 3, 2022 (2 weeks)
# of Student Slots Available * 0 1 2 3 4 or more
Please indicate how many slots are available for UCA OT Level I student fieldwork May 18-29, 2020.
Specific Practice Area Slots *
LEVEL I FW-OCTOBER
The experiential learning rotation listed below will focus on Evaluation and Intervention, including assessments, intervention plans, intervention, and transfers, when applicable. Course objectives are available upon request.
LEVEL I Fieldwork, Evaluation & Intervention
Oct. 24 - Nov. 4, 2022 (2 weeks)
# of Student Slots Available * 0 1 2 3 4 or more
Please indicate how many slots are available for UCA OT Level I student fieldwork October 19-30, 2020.
Specific Practice Area Slots *
LEVEL II FIELDWORK
LEVEL II Fieldwork, Rotation 1
January 2 - March 24, 2023 (12 weeks)
# of Student Slots Available * 0 1 2 3 4 or more
Please indicate how many slots are available for UCA OT Level II student fieldwork January 4-March 26, 2021.
If a reservation slot above is open in a specific practice area (e.g. Acute, Burns, NICU, Outpatient Hands, Psych, etc.), please designate below.
Specific Practice Area Slots *
LEVEL II Fieldwork, Rotation 2
March 27 - June 16, 2023 (12 weeks)
# of Student Slots Available * 0 1 2 3 4 or more
Please indicate how many slots are available for UCA OT Level II student fieldwork March 29-June 18. 2021
If a reservation slot above is open in a specific practice area (e.g. Acute, Burns, NICU, Outpatient Hands, Psych, etc.), please designate below.
Please submit at your earliest convenience. If you have questions contact Megan Orton: morton@uca.edu
Specific Practice Area Slots *
Student Requirements and Site-specific Information *

Indicate specific student assignments and any information/requirements students need prior to coming such as vaccinations.
By checking the box below, I assure the educator assigned to the level II fieldwork student will have, at the time of the experience, "a minimum of 1 year full-time (or its equivalent) of practice experience subsequent to initial certification and who is adequately prepared to serve as a fieldwork educator." (Accreditation Council for Occupational Therapy Education-ACOTE standard C.1.14.) * Assure Cannot assure

FIELDWORK RESERVATIONS

FIELDWORK RESERVATIONS

LEVEL I FIELDWORK

LEVEL I FW-MAY The experiential learning rotation listed below will focus on Analysis of Human Occupational Performance, including assessment and transfers, when applicable. Course objectives are available upon request.

LEVEL I FW-OCTOBER The experiential learning rotation listed below will focus on Evaluation and Intervention, including assessments, intervention plans, intervention, and transfers, when applicable. Course objectives are available upon request.

LEVEL II FIELDWORK

If a reservation slot above is open in a specific practice area (e.g. Acute, Burns, NICU, Outpatient Hands, Psych, etc.), please designate below.

If a reservation slot above is open in a specific practice area (e.g. Acute, Burns, NICU, Outpatient Hands, Psych, etc.), please designate below.

Please submit at your earliest convenience. If you have questions contact Megan Orton: morton@uca.edu

LEVEL I FW-MAY
The experiential learning rotation listed below will focus on Analysis of Human Occupational Performance, including assessment and transfers, when applicable. Course objectives are available upon request.

LEVEL I FW-OCTOBER
The experiential learning rotation listed below will focus on Evaluation and Intervention, including assessments, intervention plans, intervention, and transfers, when applicable. Course objectives are available upon request.