OTD Knoxville Supplemental Application

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OTD Knoxville Supplemental Application

South College
Occupational Therapy Dept.
ATTN: OTD ADMISSIONS
400 Goody's Lane
Knoxville, TN 37922

DEMOGRAPHIC INFORMATION

Name:

Title:

First:

Last:

Middle:

Under what other name(s) might documents be received?

Telephone number at which you can be reached between 8:00am and 5:00pm ET:

What City and State do you currently live in?

City:

State:

Date of Birth:*

Do you consider yourself to be of Hispanic/Latino origin?*

Yes

Please select the racial category with which you most closely identify.

American Indian or Alaska Native

Asian

Black or African-American

Native Hawaiian or Other Pacific Islander

White or Caucasian

Self Describe (Please use box below)

From among the following, please select the type of geographical area where you were raised:

Urban (>1,000,000 population)

Large city (100,000 to 1,000,000 population)

Mid-size city (50,000 to 99,999 population)

Large town (10,000 to 49,999 population)

Small town (2,500 to 9,999 population)

Isolated rural (<2,500 population)

From among the following statements, please select all that apply to you. *

I graduated from a high school from which a low percentage of seniors receive a high school diploma.

I participated in an academic enrichment program funded in whole or in part by the Health Careers Opportunity Program, TRiO, or Upward Bound.

I am the first generation in my family to attend college (neither my mother nor my father attended college).

I applied or plan to apply for the OTCAS application fee waiver or assistance program.

I am fluent in 2 or more languages.

English is not my primary language.

I am/will be a graduate of a minority-serving institution or HBCU.

None of these apply

PROGRAM APPLICATION

Did you review South College OTD social media accounts (Instagram, Facebook, LinkedIn) to gain more information on our program before applying?*

Yes, I have followed one or more of these accounts.

Yes, but only minimally

I did not access these accounts

At South College, we make every effort to meet students where they are and help them reach their goals. The following is a list of ways we intend to support student success.

Please let us know which of these you value the most through a rank order (1 being the most important and 9 being the least important). Please type the number associated with the importance level in the box beside each item on the list.*

Allow students to live in any geographical location via a hybrid model of education

Accelerate the time to degree (2 years to complete vs 2.5 or 3)

Foster student collaboration and team building while minimizing competition

Build a sense of community and connection between faculty and students

Provide acknowledgement and understanding of major life events

Encourage health and wellness

Promote equity, justice, and a sense of belonging

Celebrate the diversity of our program and the future patients we will serve

Communicate clearly and set clear expectations

Have you previously applied for admission to the South College OTD program?*

Yes

Which South College campus have you applied, to or intend to apply to, for admission to the OTD program? (Select all that apply)*

Atlanta

Knoxville

Why did you choose the campus(es) from above?

If the campus of choice has reached capacity, are you open to attending a different South College OTD program location?*

The South College School of Occupational Therapy has two locations with varying cohort start dates.

Atlanta (June)
Knoxville (September)

Yes

Maybe

Are you currently employed by Confluent Health?*

Yes

Unsure

HYBRID ACCELERATED MODEL OF EDUCATION

The South College OTD program offers a hybrid accelerated education model.

What has been your experience with hybrid education?

I have not taken any online/virtual courses

I have only taken online/virtual courses during the COVID shut down

I have taken 1-2 online/virtual courses that were designed to be delivered online

I have taken 3 or more online/virtual courses that were designed to be delivered online

My entire undergraduate experience was made up of online/virtual courses

If so, how do you rate the quality of your experience with online/virtual course design?*

Excellent

Good

Neutral

Poor

APPLICANT SELF-ASSESSMENT OF READINESS FOR BLENDED LEARNING

The curriculum of the South College OTD Program uses a blended learning model with delivery of the curriculum through a combination of online, onsite, and clinical learning environments. A number of personal qualities and life factors have been recognized as being relevant to the success of students participating in our accelerated OTD program. Please order each of the following attributes or skills in order of highest personal strength to relatively lowest personal strength. You will place a # between 1 and 8 to order with 1 being your strongest characteristic.

**NOTE: We recognize you may be strong in all of these attributes but we want you to place in order with strongest as #1. Please answer these questions honestly and only use each number once. Self-reflection is a critical behavior in clinical practice.

Time Management

Financial Resources

Self-Starter (motivated)

Creativity

Communication

Reading Comprehension

Writing Abilities

Determination

If accepted to this OTD program, realistically, how many hours per week do you have available to study?

1-10 hours

11-15 hours

16-20 hours

21-25 hours

26-30 hours

>30 hours

Please share any additional information about yourself or your journey that you would like us to know about you. This could be anything
that might help us support you throughout the program.

DISCLOSURE AND RELEASE STATEMENTS

ACOTE Accreditation Status Disclosure:
The entry-level occupational therapy doctoral degree program has applied for accreditation by the Accreditation Council for Occupational Therapy Education (ACOTE) of the American Occupational Therapy Association (AOTA), located at 7501 Wisconsin Avenue, Suite 510E, Bethesda, MD 20814. ACOTE’s telephone number c/o AOTA is (301) 652-AOTA and its web address is www.acoteonline.org.

The program must be granted Candidacy Status, have a preaccreditation review, complete an on-site evaluation, and be granted Accreditation Status before its graduates will be eligible to sit for the national certification examination for the occupational therapist administered by the National Board for Certification in Occupational Therapy (NBCOT). After successful completion of this exam, the individual will be an Occupational Therapist, Registered (OTR). In addition, all states require licensure to practice; however, state licenses are usually based on the results of the NBCOT Certification Examination. Note that a felony conviction may affect a graduate’s ability to sit for the NBCOT certification examination or attain state licensure.

By checking the box below, I acknowledge that I have read this statement, understand its implications, and agree to the aforementioned conditions

Yes

Please contact the campus occupational therapy department, at rmullaney@south.edu if you have questions or concerns regarding program accreditation status.

Blended Learning Acknowledgement:

The South College OTD program is a blended learning program. As such, the OTD curriculum is delivered using a combination of online

distance-based, on-site lab intensive, and clinical education course components. This means that applicants should be technically

proficient in basic internet use, have access to reliable internet, as well as able to travel to the on-site lab intensive sessions and clinical

education experiences. By checking the box below, I acknowledge that I have read this statement, understand its implications, and agree to

the aforementioned conditions.

Yes

FERPA Release

South College provides for the confidentiality of student records in accordance with the Family Educational Rights and Privacy Act (FERPA), as amended. I understand that in order to consider my application to any of the campus programs and the Occupational Therapy Department, the Office of Admissions will release my student records as necessary to members of the Occupational Therapy Admissions Committee, employees of South College and others who have a need to access my student records in order to process my application for admission.

Yes

Clothing Size

Please let us know your size for ordering t-shirts should you be offered a seat and pay your seat deposit. Letting us know will ensure quicker delivery.

T shirt Size:

As acceptance of this registration, please type your full name below.

By entering your name, the last four digits of your social security number, and submitting the document, you electronically agree and confirm your understanding of the items, as outlined, in the above document as well as authorize the payment of the Supplemental Application fee to South College.

Supplemental Payment ($60.00):

Full Name:

Last four of social:

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