Accreditation Council for Occupational Therapy Education Practitioner Application for Membership—Roster of Accreditation Evaluators (RAE) Description and Responsibilities The Accreditation Council for Occupational Therapy Education (ACOTE) is recognized by the U.S. Department of Education and the Council for Higher Education Accreditation (CHEA) as the only accrediting body for occupational therapy and occupational therapy assistant educational programs. ACOTE membership includes a Chairperson, council members representing occupational therapy and occupational therapy assistant education and practice, public members, an academic administrator, and an ex-officio AOTA accreditation staff liaison. All decisions regarding accreditation of occupational therapy and occupational therapy assistant educational programs are made by ACOTE. The Roster of Accreditation Evaluators (RAE) is a separate group of occupational therapists and occupational therapy assistants that serves the vital function of assisting ACOTE in the evaluation of occupational therapy and occupational therapy assistant educational programs. To qualify as an accreditor (RAE member), the applicant must: be either an occupational therapist or occupational therapy assistant be a member in good standing with AOTA have at least 5 years’ experience as an occupational therapy practitioner, including 3 years in education or fieldwork, OT administration, or another area of expertise NOT hold concurrent positions on any AOTA policy-making or decision-making body to include: Representative Assembly (Representative or Alternate), Board of Directors, or Ethics Commission. In addition, RAE members may not hold a position in a credentialing capacity, e.g., National Board for Certification in Occupational Therapy (NBCOT) Executive Board member or Certification Examination Item Writer Duties and Responsibilities: Successful completion of the 2½-day Accreditation Evaluator Workshop in early to mid-November 2015. Communication with AOTA accreditation staff and ACOTE. Completion of paper reviews as requested. The amount of time required to complete each paper review varies, based on such factors as the skills of the RAE reviewer, the quality of the report that is reviewed, and the depth of the report. Participation in 2½-day on-site accreditation evaluations as requested. Note that all expenses for on-site visits are fully reimbursable. Completion of peer evaluations as requested. Term of Service: 3.5 years (first term) Professional Growth: As requested, serve as a mentor to new RAE members. As requested, attend specialized accreditation workshops. As requested, serve as Team Chairperson for on-site accreditation evaluations. As invited, serve on the Accreditation Council for Occupational Therapy Education. Application and Selection Process: Applications will be accepted by the AOTA Accreditation Department until June 20, 2015. Members of the ACOTE Executive Committee, in collaboration with AOTA accreditation staff, will review all eligible applications and the final list of applicants will be reviewed by members of ACOTE. After the selections are made, all applicants, whether selected or not, will be informed of ACOTE’s decision. All selected RAE members will need to commit to the time and effort required to fulfill the responsibilities outlined for the position. The American Occupational Therapy Association, Inc. 4720 Montgomery Lane, Suite 200, Bethesda, MD 20814-3449 January 2015 Accreditation Council for Occupational Therapy Education Practitioner Application for Membership Roster of Accreditation Evaluators (RAE) PLEASE TYPE YOUR RESPONSES (If you encounter difficulties in completing this form, you may hit “Tools”, “Unprotect” to add manual edits.) Name and Degree(s)/Credentials: OT OTA Home Address: Home City, State, Zip: Home Phone: Fax: Home E-mail: Fax: Work E-mail: Job Title: Current Employer: Work Address: Work City, State, Zip: Work Phone: Preferred Mailing Address: Home or Work Initial Certification Date: Preferred E-Mail Address: Home or Work AOTA Membership Number: State licensure (indicate state and license/registration number): Institution Granting OT Degree: Yr Granted: Institution Granting Non-OT Degree: Yr Granted: Institution Granting Non-OT Degree: Yr Granted: Membership Categories (complete each applicable area) Years of Full time OT Level OTA Level Experience Check one or both Briefly Describe Place & Dates of Employment, Duties, Responsibilities, etc. * DO NOT ATTACH CV OR RESUME * Coordinator of Fieldwork Education Staff Supervisor or Department Director Practitioner (direct services) Student Supervisor Clinical Consultant Clinical Researcher Other (please specify): 2 Poor Fair Give an example that explains each rating Good Very Good Areas Evaluated Exceptional Please rate yourself on each area below and describe a strength or area to improve. Professional Behaviors/Demeanor Ethical Beliefs/Behaviors Verbal Communication Written Communication Reading Nonverbal Cues Active Listening Skills Giving Constructive Feedback Receiving Constructive Feedback Time Management/Meeting Deadlines Conflict Resolution Computer/Technology Skills Do you speak a foreign language? Indicate language & fluency Experience working as an occupational therapy assistant practitioner or working with occupational therapy assistant practitioners Please list three professional references (one must be your current immediate supervisor): Name Title Daytime Phone 1. 2. 3. Service in Professional Organizations (include dates of service): 3 Conflict of Interest: RAE members may not hold concurrent positions on any AOTA policy-making or decision-making body or an official position with the National Board for Certification in Occupational Therapy (NBCOT). Therefore, membership in the following bodies constitutes a conflict of interest: AOTA Representative Assembly (Representative or Alternate) AOTA Board of Directors AOTA Ethics Commission NBCOT Executive Board or Certification Examination Item Writer Please list any other AOTA or NBCOT positions you currently hold and the term of office. Position Term of office Position Term of office Explain, in 200 words or fewer, why you wish to join the RAE (please TYPE or PRINT). Use additional pages as necessary: Please indicate where you first heard about this volunteer opportunity (e.g., AOTA Web page, OT Practice, personal contact, etc.): By my signature, I verify that the information contained in this application is accurate. Name/Signature: Date: By June 20, 2015, please return your completed application by e-mail to accred@aota.org or by mail to the address listed below: ACOTE Accreditation Program c/o AOTA 4720 Montgomery Lane, Suite 200 Bethesda, MD 20814-3449 If you have any questions, please contact the AOTA Accreditation Department at 301-652-6611 x2914. DOCUMENT1 January 2015 4