Supplemental Application for WMU’s
Entry-Level Master’s Program in Occupational Therapy
Name:
Mailing Address, City, State, Zip:
Current Daytime Telephone:
Email Address:
WMU WIN# (if known):
Have you previously applied to this program?
Yes
No
If yes, when?
Please check the box indicating your first location preference:
Kalamazoo
Grand Rapids
Checklist for application submission – Incomplete applications will not be considered
I have submitted ALL official transcripts to the WMU Admissions Office – we must have
official transcripts from ALL previous institutions attended (except for WMU),
including your most recent work prior to the February 1 deadline. We will NOT accept
late or unofficial transcripts.
I understand all of my prerequisites (or equivalents) with a grade of “C” or better must
be completed before applying. The only exception is OT 2020 – I must be taking this
class at the time of application if it is not previously completed (Spring semester, which
begins in January).
I understand my GPA must be a 3.0 minimum (approximately the last 60 credit hours will
be calculated for graduate admission, without splitting a semester).
I am aware that I will receive notification of my admission status via mail 8-10 weeks
after the OT application deadline.
Bachelor’s degree will be completed by the Fall start date of the OT program.
I understand that if I am admitted to the OT program, I will be required to do one of the
following:
1. Enroll in HSV 3650: Info Literacy in the Health Sciences (1-credit) during the first fall
semester in the OT program (in addition to required OT courses).
2. Pass an online proficiency test on info literacy by August 1, prior to beginning the OT
program. If the test is not passed, I must enroll in HSV 3650 during the first fall
semester in the OT program. More information will be included in admission letters
and subsequent emails.
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It is the policy and commitment of Western Michigan University not to discriminate on the basis of race,
sex, age, color, national origin, height, weight, marital status, familial status, sexual orientation, religion,
disability, or veteran status in its educational programs, student programs, admissions, or employment
policies.
Note: A felony conviction may affect a student’s eligibility to be placed on Level I or II fieldwork, as well
as apply to take the National Board for Certification in Occupational Therapy Examination for OTR and
apply for a state license to practice as an Occupational Therapist.
Electronic/Typed Signature:
Date:
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Prerequisite Courses
HSV 2250: Growth, Development, & Aging
Course:
Date Taken:
Where?
Grade:
PSY 1000: General Psychology
Course:
Date Taken:
Where?
Grade:
PSY 2500: Abnormal Psychology
Course:
Date Taken:
Where?
Grade:
BIOS 2110: Human Anatomy
Course:
Date Taken:
Where?
Grade:
BIOS 2400: Human Physiology
Course:
Date Taken:
Where?
Grade:
ENGL 1050: Thought and Writing
Course:
Date Taken:
Where?
Grade:
OT 2020: Orientation to Occupational Therapy
Course:
Date Taken:
Where?
Grade:
Work/Volunteer Experiences
Please list work/volunteer experiences involving helping others from disabled, culturally
diverse, vulnerable populations.
1. Agency/Organization:
Title/Role:
Dates of Participation:
Hours Worked:
2. Agency/Organization:
Title/Role:
Dates of Participation:
Hours Worked:
3. Agency/Organization:
Title/Role:
Dates of Participation:
Hours Worked:
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Leadership/Teamwork
Please list your leadership/teamwork experiences, both paid and unpaid.
1. Event/Role:
Dates of Participation:
Total Hours:
2. Event/Role:
Dates of Participation:
Total Hours:
3. Event/Role:
Dates of Participation:
Total Hours:
Cultural Competency
Please list any courses taken that included substantial study of other cultures:
Course:
Date Taken:
Where?
Course:
Date Taken:
Where?
Course:
Date Taken:
Where?
Please list any college-level non-English language or sign language courses taken:
Course:
Date Taken:
Where?
Course:
Date Taken:
Where?
Course:
Date Taken:
Where?
Please discuss any sustained interactions and/or experiences involving diversity and inclusion and any
cultures other than your own:
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Research Courses
Please list college-level research courses taken:
Course:
Date Taken:
Where?
Course:
Date Taken:
Where?
Course:
Date Taken:
Where?
Research Experiences
List formal research projects for which you helped formulate a research plan, collected data, or
analyzed data:
Project Title:
Your Role/Duties:
Date of Project:
Further Explanation of Research Experience:
Project Title:
Your Role/Duties:
Date of Project:
Further Explanation of Research Experience:
Project Title:
Your Role/Duties:
Date of Project:
Further Explanation of Research Experience:
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Documentation of OT Experience
To ensure that all applicants are knowledgeable in the field of Occupational Therapy, a minimum
requirement of 20 contact hours with a certified Occupational Therapist(s) or COTA is required. We
required a minimum of one OT experience and a maximum of three.
Submit a completed “Documentation of OT Experience” form for each experience.
Note: No more than THREE experiences/forms can be submitted.
Forms can be found HERE.
These forms must be completed by the OT/COTA who was shadowed by the applicant and submitted by
the applicant in envelopes with the OT/COTA’s signature on the seal. Please mail all OT documentation
forms to the address below – postmarked by February 1. Confirmations will NOT be given to applicants
whose forms have been received. If you wish to receive a confirmation, please send forms via certified
mail.
Western Michigan University
College of Health and Human Services
Advising Office – ATTN: Sarah Anderson
1903 W. Michigan Avenue
Kalamazoo, MI 49008-5380
1. Agency/Facility:
Address:
Population Served:
Start/End Date of Experience:
OT/COTA Name/Title/Phone/Email:
Total Hours Worked:
OT evaluation has been sent to the above address.
Pull previous OT evaluation for the above experience (previous forms kept on file for one year)
2. Agency/Facility:
Address:
Population Served:
Start/End Date of Experience:
OT/COTA Name/Title/Phone/Email:
Total Hours Worked:
OT evaluation has been sent to the above address.
Pull previous OT evaluation for the above experience (previous forms kept on file for one
year)
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3. Agency/Facility:
Address:
Population Served:
Start/End Date of Experience:
OT/COTA Name/Title/Phone/Email:
Total Hours Worked:
OT evaluation has been sent to the above address.
Pull previous OT evaluation for the above experience (previous forms kept on file for one year)
**If you have any questions or need clarification as you complete this application, please contact Sarah
Anderson, OT advisor, at sarah.anderson@wmich.edu
End of Supplemental OT Master’s Application
updated May 2015
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