Confirmation of Fieldwork Educator’s Professional Qualifications

In order to comply with accreditation standards of the Accreditation Council for Occupational Therapy Education (ACOTE), the department must verify that each fieldwork educator is qualified to supervise Level II students. Please assist us by completing the form and returning it prior to the start of the student’s fieldwork experience.

I, ______________________________ confirm that __________________________________________

Fieldwork Coordinator                                                            Fieldwork Educator Name and Credentials

has a minimum of one year of practice experience subsequent to initial certification and is adequately prepared to serve as a fieldwork educator.

_____________________________________________                                        _________________________

Fieldwork Coordinator Signature                                                    Date