Occupational Therapy Assistant Program Application - Non SSO

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Occupational Therapy Assistant Program Application

*MANDATORY – Notifications will be made via email. Please ensure email address is correct.

Status of Application

Semester you are applying for

Texas Driver's License

DL Exp. Date

First Name

Middle Name

Last Name

Street Address

City

State

Postal/Zip Code

Home Phone

Cell Phone

Email Address:

Date of Birth

Age

Gender

Race

Ethnicity

Health Insurance

Name of Company

Emergency Contact

Emergency Contact Phone

Highest Degree Earned

Month/Year (MM/YYYY)

Have you previously been accepted or enrolled in another OT or OTA program?

If yes, please list the school(s) under prior education.

Can we notify the schools?

Have you attended an information session?

Prerequisite Requirement Table

**If a course is currently in progress, please indicated IP in Grade column.**

ENGL 1301 Composition I

Semester/Year Taken

Grade

University or School Name

MATH 1314 College Algebra

Semester/Year Taken

Grade

University or School Name

BIOL 2301 Anatomy Physiology I (lecture)

Semester/Year Taken

Grade

University or School Name

BIOL 2101 Anatomy Physiology I (lab)

Semester/Year Taken

Grade

University or School Name

BIOL 2302 Anatomy Physiology II (lecture)

Semester/Year Taken

Grade

University or School Name

BIOL 2102 Anatomy Physiology II (lab)

Semester/Year Taken

Grade

University or School Name

PSYC 2301 General Psychology

Semester/Year Taken

Grade

University or School Name

PHIL 2306 Ethics

Semester/Year Taken

Grade

University or School Name

References
(List the 3 names & emails of those individuals on your recommendation form)

References must directly submit recommendation forms to OTAprogram@sjcd.edu in PDF format.

Reference Name

Reference Email

Reference Name

Reference Email

Reference Name

Reference Email

My GPS Report

Upload unofficial transcripts from colleges & universities

Transcript Upload 1

Add New Entry

Upload proof of employment (if applicable)

Employment Upload 1

Add New Entry

Application Checklist

I have typed the name and email of three references.

I uploaded My GPS report to this application.

I have uploaded unofficial transcripts from all colleges and universities attended to this application.

I have submitted official transcripts to the San Jacinto College Admissions Office (Record Management) for all colleges and universities attended.

I have included proof of employment for credit in related healthcare work experience (if applicable).

Applicant Acknowledgement

This application will be used in the accumulation of points for the admission process. Final decisions on point allocation will be determined by the program director.

I hereby certify that the information in this application is true and complete to the best of my knowledge. I understand that any misrepresentation or falsification is cause for denial of admission or expulsion from the college. I understand that the faculty and staff of the San Jacinto College South- Occupational Therapy Assistant Program will read the information contained in this application.

I Acknowledge

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Occupational Therapy Assistant Program Application - Non SSO

Occupational Therapy Assistant Program Application

Prior Education (list most recent first)

Employment Record (list most recent or present position)