University of Washington Neurologic Physical Therapy Residency Program
University of Washington
Neurologic Physical Therapy Residency Program
Application
Please print out application form and return in one complete packet to:
University of Washington Medical Center - Physical Therapy
Attention: Victoria Stevens, PT, NCS
Box Number 356154
1959 NE Pacific Street
Seattle, WA 98195-6154
Deadlines: Completed application forms, all supporting materials (official transcript,
letters of recommendation), and the application fee must be received no later than
February 1, 2013. Top applicants will be granted an in-person interview on April 15, 2013 and
notification of acceptance will occur by mid-May. The 12-month program begins on August 1,
2013.
For any questions regarding the application process, please contact Vicki Stevens at
vstevens@u.washington.edu or Stacia Lee at staciale@u.washington.edu.
Applicant Components:
1. Contact information sheet (see below)
2. Personal Statement addressing the following:
a. Why you are pursuing a clinical residency experience
b. Your personal and professional goals for participating in the residency program
c. Specific qualifications that makes you a good candidate for the University of
Washington Neurologic Physical Therapy Residency Program
Please limit to 2 pages, double spaced.
3. Current Curriculum Vitae that includes at least the following (if applicable):
a. Education (institute, degree, years of attendance)
b. Professional experience. If you have less than 1 year experience as a licensed
Physical Therapist, please include your Physical Therapy affiliations that were at
least 10 weeks long.
c. Teaching experience
d. Continuing education courses, including course name, instructor, and approximate
number of contact hours
e. Other neurology specific experience and/or course work
f. Other recognition
4. One official copy of transcript from completed Physical Therapy Graduate Program.
5. Two letters of recommendation and Applicant Rating Forms (see below) from individuals
who know your academic and/or clinical potential as a Physical Therapist.
2013-2014 Application Form
University of Washington Neurologic Physical Therapy Residency Program
a. For individuals within 2 years of graduation from a physical therapy program:
i. One letter of reference and rating form should come from an academic
professor or advisor.
ii. One letter of reference and rating form should come from a clinical
instructor or recent employer.
b. For individuals who have greater than 2 years of experience as a physical
therapist, both letters should come from professional references (colleagues
and/or supervisors) who have the ability to best speak to your professional
practice.
Have the individual place the letter of recommendation and Applicant Rating Form in a
sealed envelope with his/her signature across the seal, and mail the sealed envelope with
your application. The letter should address:
- How does the applicant compare to other physical therapy students or employees
you have had?
- How does this applicant handle stress?
- Did the applicant demonstrate evidence-based practice?
- How did the applicant’s clinical reasoning develop and progress over time?
- What would you like us to know about this applicant?
6. Current Physical Therapy License for Washington State:
a. Participants must show evidence of full licensure by August 1, 2012, the start of
the program. Full licensure means passing the licensing exam and currently in
possession of a valid Washington state physical therapy license. The University
of Washington Medical Center Neurologic Physical Therapy Residency Program
reserves the right to rescind an applicant’s offer if no proof of full licensure is
made available.
b. Out-of-state applicants are encouraged to initiate their Washington Physical
Therapy licensure at the same time an application is made to the program. The
licensure process normally takes 4-5 months to complete for U.S. trained Physical
Therapists. To obtain the Washington Physical Therapy licensure application,
contact:
Washington State Department of Health
Board of Physical Therapy
PO Box 47877
Olympia, WA 98504-7877
(360) 236-4700
http://www.doh.wa.gov/hsqa/professions/Physical_Therapy/forms.htm
7. Application fee of $30.00 payable to University of Washington Medical Center Physical
Therapy Department.
2013-2014 Application Form
University of Washington Neurologic Physical Therapy Residency Program
University of Washington
Neurologic Physical Therapy Residency Program
Contact Information
Last Name
First Name
Middle Name
Mailing Address
City
State
Preferred Phone Number
Email Address
2013-2014 Application Form
Zip Code
University of Washington Neurologic Physical Therapy Residency Program
University of Washington Neurologic Physical Therapy Residency Program
Letter of Reference and Applicant Rating Form
Instructions to Applicant: Please print this form for each individual from whom you request a letter of reference. Complete the
Applicant Statement before giving this form to the individual from whom you request a letter. One letter of reference and applicant
rating form should come from an academic professor or advisor, and one letter of reference and applicant rating form should come
from a clinical instructor or recent employer. The completed letter of recommendation and Applicant Rating Form should be placed
in a sealed envelope, and the individual providing this reference should place their signature across the seal. Mail the sealed envelope
with your application.
Applicant’s Statement:
I understand that under the provisions of the Federal Family Education Rights and Privacy Act of 1975, I have access to my “letters of
recommendation.”
I
DO or DO NOT (circle one)
wish to waive my access to this letter of recommendation.
I understand that a waiver of access to my file is not required as a condition for admission or any other services or benefits.
Applicant Name (print)
Applicant Signature
Date
Instructions to Rater: You are being asked to provide a letter of reference and applicant rating for the above individual for
application to the University of Washington Neurologic Physical Therapy Residency Program. Please complete the Applicant Rating
Form (below) and a brief letter of reference that elaborates on the applicant’s strengths and weaknesses as a potential participant in a
Neurologic Physical Therapy Residency Program. Your letter should address the following questions:
a. How does the applicant compare to other physical therapy students or employees you have had?
b. How does this applicant handle stress?
c. Did the applicant demonstrate evidence-based practice?
d. How did the applicant’s clinical reasoning develop and progress over time?
e. What would you like us to know about this applicant?
Please place completed Applicant Rating Form and letter of reference in a sealed envelope with your signature across the seal
and return to applicant.
2013-2014 Application Form
University of Washington Neurologic Physical Therapy Residency Program
University of Washington Neurologic Physical Therapy Residency Program
Letter of Reference and Applicant Rating Form
Rater Information:
Name
Title
Relationship to Applicant
Preferred Phone Number
Email
Signature
Date
Please complete the following Applicant Rating Form. A description of items is provided on the following page.
Applicant’s Ability or Characteristic
(see next page for examples)
Knowledge Areas
Foundation Sciences
Behavioral Sciences
Clinical Sciences
Sciences Related to
Critical Inquiry
Professional Roles,
Leadership
Responsibilities, and
Virtuous Behavior
Values
Education
Consultation
Evidence-Based
Practice
Patient/Client
Examination
Management
Evaluation
Not Observed
Below Entry- Level
Entry-Level
Above Entry-Level
Board Certified
Specialist Level
Diagnosis
Prognosis
Intervention
Outcomes
Overall Recommendation:
Strongly Recommend
2013-2014 Application Form
Recommend
Recommend with Reservation
Do Not Recommend
University of Washington Neurologic Physical Therapy Residency Program
University of Washington Neurologic Physical Therapy Residency Program
Letter of Reference and Applicant Rating Form
Definitions of Applicant’s Ability or Characteristic (based on the Physical Therapy Neurologic Description of Specialty Practice):
I. Knowledge Areas of Neurologic Clinical Specialists
A. Foundation Sciences: including changes across the lifespan, Anatomy/Neuroanatomy, Physiology/Neurophysiology,
Movement Science, Physics
B. Behavior Sciences: Psychology/Neuropsychology, Teaching and Learning Theory, Communication, Decision Making
C. Clinical Sciences: Kinesiology, Pathokinesiology, Pathology, Pharmacology, Motor Development, Psychiatry,
Epidemiology
D. Sciences Related to Critical Inquiry: Research Design, Statistics
II. Practice Expectations
A. Professional Roles, Responsibilities, and Values
1. Leadership: models professionalism and maturity in decision making and interpersonal interactions, identifies
multiple strategies to resolve a problem, collaborates with others to solve problems
2. Virtuous Behaviors: Commitment, caring, and compassion. Models respect and compassion for all people,
establishes trustworthy relationships with colleagues, patients/clients, employers, and the public.
3. Education: implements, evaluates, and modifies an educational plan/learning experience, educates Physical
Therapy students, Physical Therapists, health care professionals to enhance knowledge in Physical Therapy.
4. Consultation: effectively contributes to patient management in multidisciplinary setting, develops and
implements new programs to promote health and fitness
5. Evidence-Based Practice: evaluates and appropriately applies new research information to clinical practice,
participates in planning and conducting clinical research
B. Patient/Client Management
1. Examination: History, Systems Review, Tests and Measures
2. Evaluation: develops clinical judgment based on data collected from the examination
3. Diagnosis: interprets data from the examination to develop a differential diagnosis
4. Prognosis: predicts optimal level of improvement in function, develops a plan of care that prioritizes
interventions
5. Intervention: selects and modifies interventions based on an on-going evaluation and prognosis and changes
across the lifespan, type and severity of involvement, and potential benefit relative to physiological or fiscal cost
to the patient
6. Outcomes: selects appropriate outcome measures, analyze and interpret data to modify own future practice
For questions regarding this form, please contact Vicki Stevens at vstevens@u.washington.edu or Stacia Lee at
staciale@u.washington.edu
2013-2014 Application Form