National Board for Certification in Occupational Therapy, Inc.

(NBCOT)

2001 CANDIDATE HANDBOOK

Paper-and-Pencil Administrations

Certification Examinations for

OCCUPATIONAL THERAPIST REGISTERED OTR

CERTIFIED OCCUPATIONAL THERAPY ASSISTANT COTA

Examination Dates Filing Deadlines

March 17, 2001 January 12, 2001
July 21, 2001 May 1, 2001

PLEASE RETAIN THIS HANDBOOK UNTIL YOU HAVE RECEIVED YOUR EXAMINATION SCORE REPORT.
 National Board for Certification in Occupational Therapy, Inc. (NBCOT)
800 South Frederick Avenue, Suite 200
Gaithersburg, MD 20877-4150
Telephone (301) 990-7979 FAX (301) 869-8492
WWW.NBCOT.ORG

All correspondence and requests for information concerning the administration of the certification
examinations should be directed to:

Professional Examination Service (PES)

NBCOT Testing Office
111 8th Avenue, Room 526
New York, NY 10011-5290
Telephone (212) 367-4389
Telephone: (877) 314- 0786 (for online application assistance)
FAX (212) 367-4343

NBCOT does not discriminate against any individual because of race, ethnicity, gender, age,
creed, disability, or national origin.

NBCOT reserves the right to amend the procedures outlined in the 2001 Candidate Handbook.
Please check the NBCOT web site – www.nbcot.org - for the most up-to-date
information/announcements concerning the certification examination program.

NBCOT does not administer, approve or endorse review or preparatory courses, guides or other
publications offered to the public in relation to the NBCOT certification examinations in
occupational therapy.

PLEASE RETAIN THIS HANDBOOK UNTIL YOU HAVE RECEIVED YOUR EXAMINATION
SCORE REPORT. IT CONTAINS INFORMATION AND FORMS YOU MAY NEED.

OCCUPATIONAL THERAPIST REGISTERED OTR and CERTIFIED OCCUPATIONAL THERAPY

ASSISTANT COTA are registered certification marks of the National Board for Certification in
Occupational Therapy, Inc.

 2000 by National Board for Certification in Occupational Therapy, Inc.

ALL RIGHTS RESERVED.

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TABLE OF CONTENTS

CERTIFICATION EXAMINATION ELIGIBILITY ...........................................................................................................2

THE THREE (3) EXAMINATION ADMINISTRATION LIMIT AND ELIGIBILITY REINSTATEMENT ............3
ONLINE APPLICATION PROCESSING........................................................................................................................3

HOW TO APPLY FOR THE CERTIFICATION EXAMINATION ....................................................................................4

THE OFFICIAL FINAL TRANSCRIPT TO DOCUMENT ELIGIBILITY ...................................................................4
NBCOT ACADEMIC CREDENTIAL VERIFICATION FORM (ACVF) ......................................................................5
FIELDWORK VERIFICATION BY THE PROGRAM DIRECTOR .............................................................................5
SPECIAL TESTING ACCOMMODATIONS FOR CANDIDATES WITH DISABILITIES........................................5
IMPORTANT POSTMARK DEADLINE DATES ............................................................................................................6
COMPLETING THE EXAMINATION APPLICATION FORM ........................................................................................7
THE PAPER (SCANTRON) FORM....................................................................................................................................7
THE ONLINE APPLICATION FORM ..............................................................................................................................7
THE RESUBMISSION OF THE EXAMINATION APPLICATION FOR CORRECTION.........................................8
COMPUTER-BASED COTA/OTR PRACTICE EXAMINATION .................................................................................9
TEST CENTERS .................................................................................................................................................................10
CHANGE OF TEST CENTER...........................................................................................................................................11
SOCIAL SECURITY NUMBER ........................................................................................................................................12
FELONY RELATED QUESTIONS...................................................................................................................................12
SCORE REPORTS TO JURISDICTIONS THAT ACCEPT NBCOT SCORES..........................................................13
STUDENT ID NUMBER ....................................................................................................................................................13
BACKGROUND INFORMATION....................................................................................................................................14
SIGNATURE........................................................................................................................................................................15
FEES .....................................................................................................................................................................................16
AFTER THE APPLICATION HAS BEEN SUBMITTED..................................................................................................16
POSTCARD AND ONLINE ACKNOWLEDGMENT OF THE RECEIPT OF THE EXAMINATION
APPLICATION ...................................................................................................................................................................16
ACKNOWLEDGMENT OF THE RECEIPT OF THE WEB-BASED APPLICATION..............................................16
CONFIRMATION OF RECEIPT OF THE OFFICIAL FINAL TRANSCRIPT AND/OR NBCOT ACVF..............17
CONFIRMATION OF EXAMINATION ELIGIBILITY & COMPLETED EXAMINATION REGISTRATION...17
WITHDRAWALS, REFUNDS, AND ABSENCES...........................................................................................................17
ADMISSION NOTICE........................................................................................................................................................18
ON EXAMINATION DAY ..........................................................................................................................................18
IDENTIFICATION AT THE TEST CENTER .................................................................................................................18
REPORTING TIME AND ADMINISTRATION TIME .................................................................................................18
HAZARDOUS WEATHER ................................................................................................................................................18
SECURITY...........................................................................................................................................................................19
AFTER THE EXAMINATION ......................................................................................................................................19
SCORING THE EXAMINATION.....................................................................................................................................19
SCORE REPORTS AND CERTIFICATES......................................................................................................................19
HAND SCORING ................................................................................................................................................................20
NAME CHANGE.................................................................................................................................................................20
EXAMINATION CHALLENGES, COMPLAINTS AND APPEALS............................................................................20
SCHOOL CODES................................................................................................................................................................21
EXAMINATION CONTENT .............................................................................................................................................26
FORMS ......................................................................................................................................................................30
 INTRODUCTION
The National Board for Certification in Occupational Therapy, Inc. (NBCOT) is a not-for-profit credentialing agency
responsible for the development and implementation of all policies related to the certification of occupational therapy
personnel. It is an independent national credentialing agency that certifies eligible persons as OCCUPATIONAL
THERAPIST REGISTERED OTR® or CERTIFIED OCCUPATIONAL THERAPY ASSISTANT COTA®, hereinafter referred to
as OTR or COTA, respectively. NBCOT is not affiliated with the American Occupational Therapy Association, Inc.
(AOTA) or any state regulatory agency. NBCOT works with Professional Examination Service (PES), a not-for-profit
testing company to administer and score the examinations in conformance with the standards established by the
National Council on Measurement in Education (NCME), the American Psychological Association (APA) and the US
Equal Employment Opportunity Commission (EEOC).
The examinations are developed by the Certification Examination Development Committee (CEDC) of NBCOT, a
group of content experts (COTAs and OTRs) drawn from a wide variety of work environments, geographical areas and
diverse backgrounds. As objective measures of the knowledge and skills required of entry-level COTAs and OTRs, the
certification examinations are based on NBCOT’s practice analysis, National Study of Occupational Therapy Practice.
These examinations are based on the important and essential tasks and knowledge associated with occupational
therapy entry-level practice identified in the study.
The examination items are written by COTA and OTR content experts who are trained item writers. Items which
appear on the certification examination have been subjected to rigorous review and have been validated by the CEDC
as appropriate for the assessment of the knowledge and skills which are essential and important for entry-level
performance as well as important in differentiating adequate from inadequate entry-level performance. The items are
also reviewed for bias, making sure that the context, setting, language, descriptions, terminology and content of the
item are inoffensive, free of stereotype and equally appropriate for all segments of the candidate population.

CERTIFICATION EXAMINATION PAPER-AND-PENCIL ADMINISTRATION DATES FOR THE

YEAR 2001

THIRD SATURDAY IN MARCH MARCH 17, 2001

Application Postmark Deadline JANUARY 12, 2001

THIRD SATURDAY IN JULY JULY 21, 2001

Application Postmark Deadline MAY 1, 2001

(A third administration is scheduled for September. It is a computer-delivered examination and information about its
administration and the application procedures will be discussed in a separate handbook available in the spring of 2001.)

CERTIFICATION EXAMINATION ELIGIBILITY

ELIGIBILITY REQUIREMENTS FOR US GRADUATES TAKING THE COTA OR OTR EXAMINATION
Prior to being admitted to the examination, US graduates must have:
1. Completed the appropriate assistant-level or therapist-level fieldwork required by the educational program.
2. Been awarded the appropriate degree/certificate in occupational therapy/occupational therapy assistant or be
cleared for graduation (graduation is CERTAIN – all grades have been recorded and there are no outstanding
financial obligations to the institution) from an education program accredited by the Accreditation Council for
Occupational Therapy Education (ACOTE).
3. Submitted official documentation (i.e., official final transcript or NBCOT Academic Credential Verification
Form from their registrar prior to the transcript/ACVF receipt deadline) confirming examination eligibility. All
candidates are required to submit an official final transcript as evidence of being awarded the degree/certificate.

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 IMPORTANT DATES REGARDING EXAMINATION ELIGIBILITY AND ADMISSION FOR US GRADUATES
To Take the March 17, 2001 Examination:
Complete all fieldwork and be awarded the degree or cleared for graduation (graduation is CERTAIN) by
FEBRUARY 15, 2001. Submit official transcript or NBCOT Academic Credential Verification Form postmarked by
FEBRUARY 15, 2001.

To Take the July 21, 2001 Examination:

Complete all fieldwork and be awarded the degree or cleared for graduation (graduation is CERTAIN) by
JUNE 15, 2001. Submit official transcript or NBCOT Academic Credential Verification Form postmarked by
JUNE 15, 2001.

ELIGIBILITY FOR INTERNATIONALLY EDUCATED THERAPISTS

Internationally educated candidates are pre-screened by NBCOT to take the certification examination for
OCCUPATIONAL THERAPIST REGISTERED OTR®. The eligibility requirements are included in the International Pre-
Screening Packet that may be obtained from NBCOT’s International Department.
ELIGIBILITY FOR “LICENSURE ONLY” CANDIDATES
A “Licensure Only” candidate has been directed by a regulatory agency to take the examination for state regulation
purposes only and must be pre-approved to take the examination by the regulatory agency. “Licensure Only”
candidates should contact the regulatory agency for approval to examine and upon approval by the regulatory agency
NBCOT will send the application.

THE THREE (3) EXAMINATION ADMINISTRATION LIMIT AND ELIGIBILITY REINSTATEMENT

Effective with the September 2000 administration of the certification examinations for OTR and COTA, the “three
consecutive administration limit and eligibility reinstatement” policy has been rescinded. Candidates who met the
examination limit with the September 2000 examination are advised that they may re-test at the next available
examination administration. All candidates taking the certification examination, including those who previously met
the limit, may continue to examine until they are successful.

Candidates taking the examination for “licensure only purposes” are advised to check with their regulatory board to
determine whether there are any limits on the number of times a candidate may take the examination. “Licensure
only” candidates must be pre-approved by their regulatory board before submitting an application to take the
examination for licensure purposes.

Candidates who request the Confirmation of Examination Registration and Eligibility to Examine Notice are advised
that there examination history dating back to 1997, will be reported on the confirmation notice. See page 17 of the
handbook for details about the Confirmation of Examination Registration and Eligibility to Examine Notice.

ONLINE APPLICATION PROCESSING

NBCOT offers certification examination application processing online through the World Wide Web. Candidates who
have submitted the examination application who did not concurrently apply to take the practice examination, may
also apply online for NBCOT’s computer-delivered practice examination. The link for the online application can be
found at http://www.nbcot.org. This Candidate Handbook and its accompanying forms can be viewed and printed out
through this link. Candidates will find instructions and cues to assist in completion of the online form. NBCOT
encourages candidates to use this online format, as it will greatly reduce the possibility of submitting an incomplete
application which would have to be returned to the candidate. If you have questions about how to complete the
online application form, please contact PES at 877-314-0786.

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 HOW TO APPLY FOR THE CERTIFICATION EXAMINATION
SUBMIT THE APPLICATION FORM
All candidates must submit an original scantron (computer-read, paper) examination application form OR complete
the NBCOT’s web-based examination application form for a 2001 examination. The application must include
appropriate fee(s) and be sent to Professional Examination Service (PES) by the postmark deadline date (see the table
on page 6). Any other forms which may be required are found in this handbook and on the web site. An envelope is
provided for your convenience for submitting the scantron form. To use NBCOT’s web-based examination
application processing system, candidates should access the NBCOT web site – http://www.nbcot.org – and follow
the instructions provided. The same timeframes (e.g.,, deadlines) and requirements apply to both the submission of
the scantron (paper) application form and the web-based application. Any candidate (except “Licensure Only”) who
was unsuccessful on a 2000 certification examination and remains eligible to take the next scheduled administration
will be contacted by NBCOT concerning the application process for the next scheduled administration of the
examination. “Licensure Only” candidates should contact their regulatory agency first if they wish to take a future
administration of the examination. Previous years’ application forms cannot be submitted.
US graduates are required to submit documentation from their registrar and/or education program confirming that they
have met all requirements (i.e., degree and field work) for admission to the examination. ANY CANDIDATE WHO IS
REPEATING THE EXAMINATION AND HAD THE COMPLETION OF FIELDWORK VERIFIED AND/OR PROVIDED THE REQUIRED
DOCUMENTATION (I.E., OFFICIAL FINAL TRANSCRIPT AND ACVF IF NEEDED TO SUPPLEMENT TRANSCRIPT INFORMATION) FOR A
PREVIOUS ADMINISTRATION NEED NOT RESUBMIT. DOCUMENTATION REMAINS ON FILE.

• US graduates taking the examination for the first-time, within one year of graduation, may apply online or
submit their application and fees directly to Professional Examination Service (PES). No application pre-
approval by NBCOT is required.
• ALL OTHER CANDIDATES (e.g.,, repeating US graduates, US graduates examining more than one year after
graduating, international candidates) must contact NBCOT directly (before submitting an application to PES) in
order to be approved to receive an NBCOT-approved scantron (paper) application or to receive approval to use
the web-based examination application.

THE OFFICIAL FINAL TRANSCRIPT TO DOCUMENT ELIGIBILITY

Examination eligibility must be confirmed BEFORE admission to the examination. US graduates are required to
submit either the official final transcript from the institution’s registrar’s office or the NBCOT Academic Credential
Verification Form (ACVF) completed by the registrar. However, within ninety (90) days of taking the examination an
official final transcript must be received and on file for any candidate who submitted the ACVF in lieu of the official
final transcript. The official transcript should be sent in a sealed envelope directly from the institution’s registrar to
PES. Student copies (e.g., marked “student copy”, “issued to student”) of the transcript or any photocopy of the
transcript cannot be accepted. Letters will not be accepted in lieu of the official final transcript or the NBCOT ACVF.

If the candidate has already submitted an official final transcript to NBCOT or PES (between 1997 and 2000), it need
not be resubmitted.

The official FINAL transcript should report the following information:

1. Candidate’s full name
2. Candidate’s social security number or student identification number
3. Name of the institution awarding the degree/certificate in occupational therapy
4. Listing of all courses completed and required for the degree/certificate in occupational therapy
5. Identification of the major in “occupational therapy” or "occupational therapy assistant"
6. Title of the degree/certificate awarded in occupational therapy (e.g.,, Bachelor of Arts, Associate Arts, Post-
Baccalaureate Certificate)
7. The date on which the degree/certificate was awarded/conferred
8. The registrar’s official seal or stamp.
It is the candidate’s responsibility to ensure that the official final transcript submitted contains ALL of the information
listed above. Transcripts marked “student copy” or “issued to student” or similar language will not be accepted. If the
candidate’s official final transcript contains ALL of the above information no other documentation from the registrar is

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required. The registrar should send only the official final transcript in a sealed envelope postmarked by the deadline
date to:
Professional Examination Service
NBCOT Testing Office/Transcript Processing
111 8th Avenue, Suite 526
New York, NY 10011-5290

If the candidate’s official transcript does not contain all of the information listed above or the complete final transcript
cannot be submitted by the postmark deadline, the candidate MUST have the registrar complete and submit NBCOT
Academic Credential Verification Form (ACVF) in lieu of the transcript. See the table on page 6 regarding deadline
dates for the submission of the official final transcript and the ACVF.

NBCOT ACADEMIC CREDENTIAL VERIFICATION FORM (ACVF)

Any US candidate who has completed fieldwork and been awarded the degree OR has been cleared for graduation
(i.e., graduation is CERTAIN) but cannot meet the deadline for the submission of the official final transcript must have
the registrar complete and submit NBCOT Academic Credential Verification Form (ACVF). The ACVF, provided in
this handbook and online, is the only document accepted in lieu of the official final transcript. Any candidate whose
transcript is incomplete should have the registrar complete and submit the ACVF. Please confirm with the registrar
what information is posted to the transcript in order to determine whether the ACVF is needed. The ACVF must be
sent in a sealed envelope directly from the registrar to the address noted above. See page 6 for the deadline date for
submission.
All candidates submitting the ACVF prior to the examination administration date, in lieu of the official final transcript,
MUST submit an official final transcript within ninety (90) days after the examination administration date. To submit
the transcript, have the registrar send the transcript in a sealed envelope directly to PES. Failure to submit an official
final transcript within ninety (90) days after taking the examination will result in an investigation of the candidate’s
examination eligibility. REGISTRATION FOR THE EXAMINATION IS NOT COMPLETE IF THE OFFICIAL FINAL
TRANSCRIPT OR ACVF HAVE NOT BEEN RECEIVED. Neither the ACVF nor the official final transcript will be
accepted if postmarked after the deadline date.

FIELDWORK VERIFICATION BY THE PROGRAM DIRECTOR

Candidates graduating from programs which award the degree before the required fieldwork is completed must have
the completion of the fieldwork verified to NBCOT by the occupational therapy program director. Candidates should
check with the program director to be sure NBCOT has been notified that you have completed the required fieldwork.
Program directors from the occupational therapy programs listed below must submit to NBCOT a listing of the names
of all candidates who have completed the required fieldwork. For candidates from these programs, examination
registration is not complete if the completion of fieldwork has not been verified.

School Code School Name School Code School Name

12521 Greenfield Community College 23906 Ohio State University
21101 Howard University 20609 Southern California, University of
13907 Lourdes College 20103 Tuskegee University
12513 Massachusetts Bay Community College 25509 Wisconsin-Milwaukee, University of
25505 Mount Mary College

DOCUMENTATION OF THE NEED FOR SPECIAL TESTING ACCOMMODATIONS FOR CANDIDATES WITH
DISABILITIES
In compliance with the Americans with Disabilities Act (ADA), NBCOT makes special testing arrangements for
candidates with diagnosed disabilities. Further details about the special accommodations program begin on page 47
of this handbook. By the examination application deadline, you must complete and submit to NBCOT, the
Application for Special Accommodations for Candidates with Disabilities to apply for accommodations. In applying
for accommodations, an appropriate professional knowledgeable about your disability will also need to complete
portions of the accommodation application and make recommendations regarding appropriate and reasonable testing
accommodations. You should consult with this professional and agree on the accommodations being requested.

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If you have a mental disorder (e.g.,, psychological, psychiatric or learning disorder) you must also submit a
psychological or educational evaluative report. The documentation submitted should be no more than five (5) years
old. If you received accommodation during occupational therapy education please also submit the Confirmation of
Accommodation History form. If you have a medical condition which may require special testing arrangements please
submit an accommodation request. Persons with temporary conditions in need of accommodations should contact
NBCOT regarding special needs to determine if an accommodation can be provided. If you require wheelchair or
elevator access only, you may complete only the front of the accommodation application and send your request to
NBCOT. No other documentation is required. The special accommodations forms are included in this handbook and
begin on page 47. They are also available online. You may download the forms and print them in order to submit
them directly to NBCOT. All special accommodations forms and documentation must be sent by the application
postmark deadline to NBCOT, Attn: Special Accommodations, 800 S. Frederick Ave., Suite 200, Gaithersburg, MD,
20877. Persons whose primary language is NOT English are not eligible for special accommodation as this is not a
disabling condition. Additional information about special accommodations is found on NBCOT’s web site
(www.nbcot.org) or contact NBCOT.

IMPORTANT POSTMARK DEADLINE DATES FOR THE SUBMISSION OF REQUIRED

DOCUMENTS, FORMS AND WRITTEN REQUESTS
ALL DEADLINES REFERENCED THROUGHOUT THIS HANDBOOK ARE POSTMARK DEADLINES.
DOCUMENT/ITEM FOR THE MARCH 17, 2001 FOR THE JULY 21, 2001
EXAMINATION (postmarked) EXAMINATION (postmarked)
Certification Examination Application and Fees January 12, 2001 May 1, 2001
Special Accommodations Documents January 12, 2001 May 1, 2001
Resubmission Deadline – For applications February 9, 2001 June 1, 2001
submitted by the deadline above
Optional Practice Examination Application and February 9, 2001 June 1, 2001
Fees
Academic Credential Verification Form in lieu of February 15, 2001 June 15, 2001
transcript (before exam)
Request test site change February 9, 2001 June 1, 2001
Written request for partial refund of exam fee February 15, 2001 June 15, 2001
Deadline for submission of a formal complaint March 24, 2001 July 28, 2001
to NBCOT concerning the examination
Deadline for Submission of Name Change to April 7, 2001 August 11, 2001
PES (See page 10, 20 )
Deadline for request for expedited mailing of April 7, 2001 August 11, 2001
score reports
Duplicate Score Report Request – No Charge June 15, 2001 October 18, 2001
(See page 41)
Official Final Transcript (No complete official June 15, 2001 October 18, 2001
final transcript was submitted before exam.)

If the application/document is delivered to PES by a carrier other than the United States Postal Service (e.g.,, Federal
Express, United Parcel Service), the date of the shipment origination, as referenced on the shipping label, must be no
later than the postmark deadline date referenced in this handbook. PES cannot accept applications hand-delivered by
the candidate. No special accommodations application, special accommodations documentation or examination
application will be accepted after the Examination Application and Fees postmark deadline. Any examination
application “resubmitted” (after being returned to the candidate by PES) must include the resubmission fee and be

6
sent by the resubmission deadline or the application will be returned. Only applications originally postmarked to
PES on or before the application deadline date may be resubmitted to PES for corrections. Applications which do
not meet the application deadline will not be accepted.

COMPLETING THE EXAMINATION APPLICATION FORM

THE PAPER (SCANTRON) FORM

ALL sections of the scantron application form must be completed with only a No. 2 pencil. Only your signature
should be in ink. Do not alter any information on the application that has been pre-coded by NBCOT. Write only one
letter or one number in each space at the top of each box, then blacken thoroughly the oval below it. Make a copy of
the application for your records. It is recommended that you obtain proof of mailing and delivery or include the
postcard acknowledgement so that PES can acknowledge the receipt of your application.

THE ONLINE APPLICATION FORM

Detailed instructions for completing the online application form will be found at the NBCOT web site –
http://www.nbcot.org. Take care to complete all required information. If you have questions about completing the
on-line application form, you may contact PES at (877) 314-0786.
After you complete the application, you may print a copy of it for your records and you will receive a confirmation of
your application status via e-mail after you submit it for processing.
You may also use the online application process to review your scantron (paper) application after you have submitted
it for processing. If you need to make changes to certain sections of the application, you will be able to do so on-line,
even if you originally submitted your application on the scantron form. If you elect to use the online application form,
you must complete it and submit it for processing by the application deadlines in effect for the examination
administration for which you are applying.
INCOMPLETE APPLICATIONS WILL BE RETURNED UNPROCESSED
Your examination application will be returned to you unprocessed or not accepted in online completion for the
following reasons:
• No first or last name
• No address information
• Failure to complete all felony-related questions items
• Alteration of information pre-coded by NBCOT on the paper scantron form
• No social security number (international candidates excepted)
• No student identification number
• No date of birth
• No date of graduation
• No test center identified
• No school code (incomplete requirement, certification reinstatement and licensure only candidates excepted)
• No examination date specified
• No signature on scantron (paper) application form
• Payment problems (e.g.,, amount or form of payment, incorrect payee, credit card rejection)
• Failure to use a current edition of the examination application (e.g.,, using a 2000 application form for a 2001
exam)
• Use of a photocopy of the scantron form

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If your scantron application is incomplete (see above) it will be returned to you. If your online application is
incomplete (see above) you will be notified by e-mail. To resubmit your application and/or fees for correction you
will be required to pay a resubmission fee of $30 when the application and/or fees are returned to PES or when
corrections are made to the online application or fees paid. The resubmission fee is due with each and every
resubmission even if it is necessary for you to resubmit the application more than once in order for it to be complete,
all fees in order and ready for processing. The deadline dates for resubmitting the application are found on page 6.
After the examination application deadline, only applications that have met the application deadline may be
resubmitted for correction. No application, corrections, amendments or payment rectification will be accepted for
correction after the resubmission deadline.

THE RESUBMISSION OF THE EXAMINATION APPLICATION FOR CORRECTION

Note that there is no longer a late application period. All applications must be received by the Examination
Application and Fees deadline. The resubmission period is solely for resolution of issues related to applications
received by the examination application and fee deadline. See the table on page 6 for the dates during which
resubmission is permitted. A resubmission fee of $30 will be charged with each resubmission for any of the following,
whether during the resubmission period OR PRIOR TO IT, IF PES MUST CONTACT YOU FOR ADDITIONAL
INFORMATION OR PAYMENT:

No First or Last Name

Different name on transcript than on application, with no name change documentation submitted

Invalid Social Security Number

No Student ID

No Date of Birth

No Date of Graduation

No Test Center

No School Code

No Examination Date

No Signature

Rejected payment form (personal check, dishonored check, rejected credit card payment)

Inadequate payment for requested services.

Please note that completion of the application form using the online application will assist you greatly in assuring that
none of these inadequacies occur. You MAY make CHANGES to your name, address, or test center request, within
the established deadline with no resubmission charge.

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To ensure timely and accurate processing of your examination application and documentation please pay special
attention to the following information requested:

COMPUTER-BASED COTA/OTR PRACTICE EXAMINATION

NBCOT now offers optional COTA/OTR practice examinations in a computerized format through Prometric (formerly
known as Sylvan) at Prometric’s North America test sites, only. Practice examinations are available, for an additional
fee of $120.00, to candidates who have submitted a complete application and fees for the COTA/OTR certification
examination. These practice examinations consist of 100 multiple-choice format questions. Candidates are allowed 2
hours for completion. You must schedule the practice examination BEFORE the actual certification examination is
given in March or July.
You may apply to take the practice examination at the time you apply for the certification examination by making the
request on your certification examination application. If you have already submitted your examination application and
you wish to apply to take the practice examination you may submit the Application for Computer-Based Practice
Examination on page 45. This form is also available with the web-site application.
Before becoming eligible to sit for the practice examination, your application and fee for the certification examination
must be received and processed by PES. You are encouraged to apply for the practice examination as early as
possible to maximize your access to practice examination seating. If you wait to apply to take the practice
examination you may not have available the full eligibility period in which to test and may have difficulty obtaining
your preferred date. Once your application and fee have been processed to sit for the certification examination, PES
will issue and mail to you an Authorization to Test (ATT) letter. This letter documents your eligibility to take the
computer-based practice examination and explains the process for registering for the practice examination. If you
misplace your ATT letter, please notify PES immediately to obtain a duplicate.
The ATT letter you receive from PES will indicate a toll-free telephone number for contacting Prometric. A current list
of Prometric centers will be mailed to you with your ATT letter. You must call, schedule an appointment, and take the
practice examination within 45 days from the date printed on the ATT letter. Your practice examination fee will be
forfeited if you do not sit for the examination during this time period.
When calling the Prometric Call Center, be prepared to state the name of the examination sponsor – NBCOT, the title
of the certification examination that you have applied to take (COTA/OTR), your name, identification number,
telephone number and where and when you would like to test. The Prometric representative can help you locate
your closest testing center, if necessary, and will inform you of the available testing options (locations and times) for
the day and time you request. You will also receive verbal instructions regarding the appointment, cancellation and
rescheduling procedures, identification requirements and testing center location.
At the time of your scheduled appointment, once you have checked in and your identity has been verified, center
personnel will explain the testing process, and you will begin an introductory tutorial session on the computer. The
tutorial session explains the process of selecting answers and moving from question to question in the examination.
The duration of the tutorial is in addition to the 2-hour testing time allotted for taking your practice examination.
During the test, help regarding procedures is available both from the test proctor and from a "help" feature on the
computer.
Once the items are submitted for scoring you may not see the items again. At the conclusion of the practice
examination, you will receive a Performance Feedback Report. The report will provide you with the total number of
correct answers you provided on the 100-question practice examination. You will also receive information on the
number of correct answers you provided to items in each of the six performance domains of occupational therapy
practice. You are not permitted to review the answer provided to each item or to review the specific items that were
answered incorrectly. No pass/fail decision is reported. This report is provided for diagnostic purposes only. You
may find it useful in guiding your preparation for the certification examination.
The postmark deadline dates for applying to take the practice examinations are :
February 9, 2001 - Prior to the March 2001 certification examination
June 1, 2001 - Prior to the July 2001 certification examination

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NAME
The name that you provide on the application will be printed on your admission notice, score report and certificate.
If your name has been legally changed since graduation, is different from that which appears on your transcript or is
different from the name under which you previously registered and/or took the examination, you must enclose a
notarized or certified copy of the legal documentation of the change (e.g.,, marriage license, divorce decree) with the
application.
Photocopy the name change documentation and note on the copy “ submitted for proof of name change – true copy
of original.” Provide the original and the photocopy to the notary. Have the notary “notarize” the copy. Include
the notarized copy with your examination application. If you are applying online, mail the documentation of the
name change to PES. Your application cannot be processed without this documentation. If you have made any errors
in the listing of your name, you have an opportunity to correct them on the admission notice on the day of the
examination. You may only make corrections, not name changes, on the admission notice. To make changes to your
name (e.g.,, resulting from marriage) after you have submitted your application, please see the name change
instructions.
If your name is changed since submitting your examination application, complete the Name Change form on page 33
and submit it to PE S with the notarized copy of the documentation.

TEST CENTERS
Select the test center you want from those listed. Please note that there are two separate listings of test centers – one
for the March 17, 2001 administration and one for the July 21, 2001 administration. International test sites are
available for the March 2001 administrations only. The March administration is the last administration in which the
certification examination will be offered outside of North America and Puerto Rico. The July administration is limited
to the ten (10) domestic sites listed. NO OTHER SITES ARE AVAILABLE FOR THE JULY 21, 2001
ADMINISTRATIONS TO INCLUDE NON-ESTABLISHED US SITES AND ANY INTERNATIONAL SITES.
PES will send you an admission notice approximately two weeks before the examination providing you with the exact
location/address of the test center. This information is not available from NBCOT. See the table on page 6 for the last
date on which a test center change can be made.
For the March 2001 administrations only, if you are more than 250 miles away from an established US test center, you
may request a non–established US test center. There is a nonrefundable, nontransferable fee of $150.00 for a non-
established US test center. This fee is in addition to your application fee. Enter test center code 9999 on your
application. See the application form for additional information required.
For the March 2001 administrations only, to choose one of the established international test centers, indicate the
appropriate test code and enclose the $150.00 international site fee. Any site in Israel is a Sunday test site. To
request a non–established international test center submit with your completed application, at least three months
prior to the test date, a letter stating your preferred country and city. This fee is in addition to your application fee.
Enter test code 8888 on your application. There is only one additional, nonrefundable, nontransferable fee of
$150.00 for any international test site (established or non-established).
If religious convictions prevent you from taking the examination on Saturday, arrangements can be made for special
Sunday testing. Indicate that you are requesting a Sunday Test Site/ Request in the appropriate box on the application
form. A letter, on official letterhead, from clergy, other religious representative or appropriate individual MUST attest
to your need for a Sunday test center and should be submitted with the application. Saturday-Sabbath observers will
be tested on the Sunday immediately following the regularly scheduled administration, in the cities where established
centers are located. If you are a repeating candidate and have requested a Sunday test center from PES for a 1991 or
later administration, no additional documentation is required.

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 ESTABLISHED US TEST CENTERS – MARCH 2001 ADMINISTRATIONS ONLY
ALABAMA INDIANA MONTANA SOUTH CAROLINA
3302 – Birmingham 1501 – Indianapolis 6002 - Great Falls 4102 - Charleston
ARKANSAS IOWA NEBRASKA SOUTH DAKOTA
0409 – Little Rock 1604 – Cedar Rapids 2802 - Lincoln 4201 - Sioux Falls
ARIZONA KANSAS NEW MEXICO TENNESSEE
0000 – Phoenix 1703 – Kansas City 3202 - Albuquerque 4303 - Nashville
CALIFORNIA KENTUCKY NEW YORK TEXAS
0503 – Los Angeles 1806 – Richmond 0117 - Buffalo 4401 - Amarillo
0504 – San Jose 0118 - New York 4405 - San Antonio
0505 – Sacramento 0119 - Utica 4406 - Dallas
4407 - Houston
COLORADO LOUISIANA NORTH CAROLINA UTAH
0601 – Denver 1906 – New Orleans 3402 - Durham 4503 - Salt Lake City
1907 – Monroe 3403 - Charlotte
CONNECTICUT MARYLAND NORTH DAKOTA VIRGINIA
0701 – Hartford 2118 – Baltimore 3505 - Grand Forks 0004 - Richmond
3504 - Bismark
FLORIDA MASSACHUSETTS OHIO WASHINGTON
1004 – West Palm Beach 0213 – Boston 3602 - Columbus 4801 - Seattle
1008 – Gainesville 0214 – Springfield 3603 - Cleveland
GEORGIA MICHIGAN OKLAHOMA WEST VIRGINIA
1102 – Atlanta 2303 – Detroit 3703 - Oklahoma City 4904 - Charleston
1103 – Augusta 2304 – Grand Rapids
HAWAII MINNESOTA OREGON WISCONSIN
1201 – Honolulu 2402 – Minneapolis 3801 - Portland 5003 - Milwaukee
IDAHO MISSISSIPPI PENNSYLVANIA WYOMING
1301 - Boise 6001 – Jackson 3905 - Philadelphia 7001 - Casper
3906 - Pittsburgh
ILLINOIS MISSOURI PUERTO RICO Non-Established
1406 - Chicago 2603 – Columbia 5203 - Rio Piedras US Test Center - 9999
2604 - St. Louis

ESTABLISHED INTERNATIONAL TEST CENTERS – MARCH 2001 ADMINISTRATIONS ONLY

AUSTRALIA INDIA SCOTLAND UNITED KINGDOM
8009 – Sydney 8003 – Mumbai 8037 - Edinburgh 8002 – London
CANADA ISRAEL SOUTH AFRICA
8005 – Alberta 8007 – Tel Aviv 8008 – Johannesburg
8006 – Ontario NON-SATURDAY CENTER ONLY
HONG KONG PHILIPPINES TAIWAN Non-Established
8001 – Kowloon 8004 – Manila 8010 – Taipei International Test Center –
8888

ESTABLISHED TEST CENTERS – JULY 2001 ADMINISTRATIONS ONLY*

CALIFORNIA ILLINOIS NEW YORK WASHINGTON
0503 – Los Angeles 1406 - Chicago 0118 – New York 4801 - Seattle
COLORADO MASSACHUSETTS TENNESSEE
0601 - Denver 0213 - Boston 4303 – Nashville
FLORIDA MINNESOTA TEXAS
1008 - Gainesville 2402 - Minneapolis 4407 - Houston
* The July 2001 administrations are given in the United States, at these test centers, only. There are no non-
established test sites, either domestic or international.

CHANGE OF TEST CENTER

For the March 2001 administration, if you wish to change from an established US test center to an established
international test center, you must include the $150 international test site fee with your written request. If you wish to
change from an established international test site to an established US test site, your international test site fee is
nonrefundable. The postmark deadline for the submission of a written test site change request is February 9, 2001 for
the March administration and June 1, 2001 for the July administration.

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For proof of receipt of your test site change request, please send your written request to change test centers by
traceable mail (e.g.,, certified mail, return receipt requested). Facsimile transmission of this request is not
recommended. Requests to change a test center postmarked after the deadline will not be honored. For the March
2001 administration, the fee paid for any international or non-established US test site is nonrefundable.
SCHOOL CODE
US graduates must provide a school code. The application is incomplete without a correct school code. Other
candidates may already have the school code entered on the scantron application by NBCOT or will have been
provided the school code for use during online application processing. If you are completing an OTA program your
school code MUST begin with “1.” If you are completing an OT program, your school code MUST begin with “2.”
An incorrect school code will result in a delay in processing your application and assessment of a resubmission fee.
Please check to be sure that you have provided the correct school code. OTA school code listings begin on page 21
and OT school code listings begin on page 24.
ADDRESS
Provide your complete address, including state, country and zip code/postal code. If you have a five (5) digit zip code
you will have one space blank at the end of your entry. Your admission notice, score report and any other
communication will be sent to this address. A Change of Address form is located in the back of this handbook.
SOCIAL SECURITY NUMBER
US graduates and US citizens must provide their social security number on the application. Your application is
incomplete without it and will be returned. If you are not a US citizen but you are the graduate of a US program and
you have no social security number, please attach a note with your application indicating why you cannot report a
social security number. Internationally educated candidates please leave this box blank if you do not have a US social
security number.
FELONIES
You MUST answer each of the felony-related questions 4a, 4b, 4c, 4d and 4e. If you answer ‘YES’ to any one of
these questions, YOU MUST SUBMIT THE FOLLOWING TO: NBCOT, Attention: Regulatory Affairs, 800 S.
Frederick Avenue, Suite 200, Gaithersburg, MD, 20877, postmarked no later than the examination application
deadline:
• information from you (in your own words) about the nature and time of your charge(s) and/or conviction(s),
imprisonment, parole or probation;
• copies of any official court documentation that sets forth the initial charge, conviction and sentencing
requirements;
• a letter from your parole or probation officer (if you have or had one) that indicates your current status.
These documents will help the Qualifications Review Committee (QRC) of NBCOT understand your past and present
situation. However, if you have already received a favorable early determination from NBCOT and you HAVE NOT
been convicted of, or charged with an additional felony or felonies since receiving a favorable early determination,
submit a written statement with your application indicating that you have not been convicted of, or charged with an
additional felony or felonies. No additional documentation is necessary. You must, however, still answer in the
affirmative those felony-related questions that apply to you. Further details about the procedures for early
determination and qualifications review are available from NBCOT and can be found at the web address -
www.nbcot.org.
For Internationally Educated Candidates: If the term “felony charge” or “felony conviction” are not used in your
country of origin and/or country in which you received your occupational therapy education, please seek consultation
as to the equivalent terms and definitions, as defined in your country of origin or education, and answer the questions
appropriately. If you have a serious crime in your background, you should answer “yes,” and submit additional
information for the QRC's review.

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EXPEDITED MAILING OF EXAMINATION SCORES
Scores are prepared for printing and distribution approximately five weeks after the examination date. If you choose
optional expedited mailing PES will mail your scores to you via overnight mail instead of the customary regular first
class mail when scores are ready for distribution. Expedited mailing does not affect the speed with which your
answer sheet is scored or your score report is printed. You will not receive your score report within one day of
taking the examination. Only the mailing of your score report is expedited. The fee for overnight mail is $20. Be
sure to enclose the appropriate fee for this service with your application. If no fee is provided, no service can be
provided. This service is to US addresses only. Candidates in Puerto Rico or with international addresses cannot be
served. The expedited delivery may be delayed if there is no one at the address available to accept the delivery. There
is no expedited delivery on Saturday or Sunday. Postal boxes are acceptable. The fee for expedited delivery is non-
refundable. You may request expedited mailing after you have submitted the application by using the form in the back
of this handbook.

SCORE REPORTS TO JURISDICTIONS THAT ACCEPT NBCOT SCORES

If you want your examination score reported to a jurisdiction which accepts NBCOT score reports from PES, indicate
the state/jurisdiction on your application and provide the appropriate fee(s). No jurisdiction will automatically receive
your score report. At the time you submit your application, you may only request score transfers to the jurisdictions
preprinted on the application form. Do not write in any additional jurisdictions. If after you have submitted the
application you want your score to be sent to another jurisdiction listed on the application, you will need to complete
the Official Score Transfer Request Form found on page 37 and pay the fee of $20 per jurisdiction. No changes or
transfers of this request to other jurisdictions are permitted.
Almost all jurisdictions, including the District of Columbia and Puerto Rico, have some form of regulation of
occupational therapists and occupational therapy assistants. Before you begin working in any state or comparable
jurisdiction, it is essential that you meet all of the requirements of that jurisdiction. To work without a license or
permit is against the law. Certification by NBCOT is different and separate from any state or jurisdiction’s law.
Alaska, California, Hawaii, Idaho, New Jersey, and Wisconsin do not require/accept score reports. You should contact
the regulatory agency directly for details about its law/regulation and the regulatory agency’s application process.
Neither NBCOT nor PES can provide you with details about state or jurisdiction law, regulation or the regulatory
application process. Completion of the NBCOT application for the certification examination is not the same as
applying for licensure. Sending scores to the regulatory agencies of your choice does not automatically initiate your
application process to obtain a license or permit to work in the jurisdiction. Contact the jurisdiction where you desire
to work to determine its requirements. If you fail the examination, you are advised to check immediately with the
licensure/regulatory agency to determine whether you can practice in that state/jurisdiction.

STUDENT ID NUMBER
US graduates must write in the student identification number assigned by the academic institution awarding the
occupational therapy degree/certificate. Your application is incomplete without this information and will be returned
to you and you will be charged a resubmission fee. This identification number must match the student identification
number that appears on the official transcript. If your student identification number is the same as your social
security number, please enter it here again. If your number is longer than the spaces available, please enter as many
digits as will fit. If your identification number contains dashes, spaces or letters, please record the numbers only,
omitting spaces, dashes or letters. Check with your school to be sure of the accuracy of your student identification
number.

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BACKGROUND INFORMATION
The following questions are asked in order to gather demographic information. Your response to these items is
voluntary. The information you provide may be released for research or other purposes. Your responses will not be
identified by name. Each question number below corresponds to the same numbered space in the “Background
Information” section of the application.
1. What is your gender?
A. Male B. Female
2. How do you describe yourself?
A. American Indian or Native American; Inuit; Aleut F. Mexican; Mexican American; Chicano
B. Asian; Asian American; Pacific Islander G. Puerto Rican or Puerto Rican American
C. African, Black or African American (non-Hispanic) H. Caucasian/White/ (non-Hispanic)
D. Hispanic or Hispanic American I. Other
E. Latin American; South American; Central American J. Multiracial
3. What is your age?
A. under 20 B. 21-25 C. 26-29 D. 30-39 E. 40 and above
4. What is your primary language? (The language in which you are best able to express yourself.)
A. English F. African language (e.g.,, Swahili, Yoruba, Amharic)
B. Spanish G. Middle East language (e.g.,, Arabic, Turkish, Farsi)
C. French H. Pacific Region language (e.g.,, Samoan,
Hawaiian)
D. Other European (e.g.,, Italian, German) I. Other
E. Asian Language (e.g.,, Japanese, Cantonese,
Mandarin)
5. How long ago did you complete your occupational therapy education and fieldwork?
A. 3 months ago or less E. 37 months - 5 years
B. 4 months to 1 year F. 61 months - 10 years
C. 13 months - 2 years G. More than 10 years
D. 25 months - 3 years
6. If you are taking this examination to obtain initial certification or “certification reinstatement”, how many
times have you taken this examination? *
A. This is the first time I will be taking this examination E. 6-10 times previously
B. Once previously F. 11-15 times previously
C. Twice previously G. 16 or more times previously
D. 3-5 times previously
* “LICENSURE ONLY” CANDIDATES, PLEASE INDICATE THE NUMBER OF TIMES YOU HAVE TAKEN THE EXAMINATION FOR
“LICENSURE ONLY PURPOSES” NOT CERTIFICATION OR CERTIFICATION REINSTATEMENT.

7. Which of the following methods did you find most useful in preparation for this examination.
A. Exam preparation course/review sponsored by institution E. I did not prepare for the examination
B. Individual study F. NBCOT study guide
C. Group study G. Other study guide
D. Other H. NBCOT Practice Examination

US GRADUATES GO TO "SIGNATURE" SECTION. INTERNATIONALLY EDUCATED CANDIDATES CONTINUE

WITH QUESTIONS 8-16.
8. Are you a graduate of a World Federation of Occupational Therapy (WFOT) approved program?
A.Yes B.No

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9. What is your country of origin?
A. African country E. Great Britain H. Ireland K. Philippines
B. Australia F. Germany I. Israel L. Scotland
C. Canada G. India J. Japan M. Other
D. China Ireland
10. In what country did you receive your occupational therapy education?
A. African country E. Great Britain H. Ireland K. Philippines
B. Australia F. Germany I. Israel L. Scotland
C. Canada G. India J. Japan M. Other
D. China
11. Do you plan to work in the United States? (If “NO”, skip item 12 and go to 13.)
A. Yes B. No
12. If you do plan to work in the US, how long do you anticipate working ?
A. Less than 6 months B. 7 months to 1 year C. 1-2 years D. 3 years or more

13. In what area of practice do you plan to work?

A. Nursing home C. Medical Center E. Home Health
B. Community Hospital D. School System F. Other

14. How many years have you practiced as an occupational therapist?

A. Have not practiced as an OT C. 7 months to 2 years E. 6 to 10 years
B. Less than 6 months D. 3 to 5 years F. More than 10 years

15. Do you have an occupational therapy degree?

A. Yes B. No
16. Do you have an occupational therapy diploma/certificate?
A. Yes B. No

SIGNATURE
The candidate or the candidate’s representative (e.g.,, individual with power of attorney) must sign and date the
application form in ink. If an individual other than the candidate signs the application form, a notarized copy of
Power of Attorney must accompany the application. If you have previously taken this examination under a different
name, please print this name next to your signature. Include a notarized or certified copy of the documentation of
your legal name change (e.g.,, marriage license) with your application. See page 10 and 33 about name change
documentation. If you are applying online you will attest to the truth of the information provided and the
conditions stated by electing to submit your application electronically.
CANDIDATES USING A PLACEMENT AGENCY, RECRUITING FIRM OR OTHER REPRESENTATIVE
If your application has been completed and/or signed by a representative of a placement agency, a recruiting firm, or
any other representative, the individual signing the application must include a notarized copy of your Power of
Attorney granting the individual the authority to sign the application on your behalf. If your representative has made
any errors in the completion or submission of your application, neither NBCOT nor PES will mediate any disputes
between you and your representative which concern your application. Any candidate experiencing problems with a
placement agency, recruiting firm or other representative must contact that agency or representative directly. While
these agencies or other representatives may assist candidates with the preparation and submission of the application,
the candidate is ultimately responsible for the accuracy of the information provided on the application, the timely
submission of the application and the payment of fees.

15
FEES
Application Fee ..................................................................................$325.00
(partial refund of $155 is possible, see requirements on page 17)
Jurisdiction/State Reporting Fee (with application)................................$10.00
(per state, refund is possible, see requirements on page 17)
Jurisdiction/State Reporting Fee (after submitting application)..............$20.00
(per state, refund is possible, see requirements on page 17)
Confirmation of Examination Registration and Eligibility
to Examine Notice .............................................................................$40.00
(per notice)
Practice Examination Fee… . ……………………………………………………$120.00
(partial refund of $49.00 is possible, see requirements on page 17)

All of the following fees are nonrefundable:

Application Resubmission Fee ..............................................................$30.00
(required, with each resubmission up to the resubmission deadline)
International Test Center Fee.... ..........................................................$150.00
(established or non–established, March 2001 administration only)
Non-Established Test Center (US only) Fee ..........................................$150.00
(March 2001 administration only)
Expedited score reporting — Overnight Mail.........................................$20.00
You may pay your examination-related fees by credit card (i.e., MasterCard or Visa), by completing the information
requested on the scantron form or on the online form. If not paying by credit card, submit ONLY a CERTIFIED
CHECK, MONEY ORDER, STATE OR FEDERAL AGENCY CHECK, COMPANY OR CORPORATE CHECK, for the total
amount due. Make your payment payable to PES, not NBCOT. PERSONAL CHECKS ARE NOT ACCEPTED. If any
check is not honored by the financial institution, your application will be returned, your examination registration
will be canceled and you will be charged a $30 returned check fee. Problems with the form or amount of payment
will result in the return of your application and assessment of a resubmission fee in addition to any returned check
fee. See below for details regarding the refund policy.

AFTER THE APPLICATION HAS BEEN SUBMITTED

POSTCARD AND ONLINE ACKNOWLEDGMENT OF THE RECEIPT OF THE EXAMINATION APPLICATION

PES will acknowledge the date your scantron application form was received if you enclose with the application the
postcard for acknowledgment. Stamp and self-address the card. Retain the returned postcard until you receive the
admission notice. The postcard acknowledges only that your application has been received. It does not confirm that
your application is complete, that fees submitted are sufficient and proper or that your registration is confirmed. If you
have not received the postcard within 4 weeks of your mailing your application, contact PES at (212) 367-4389. You
may wish to mail your scantron application form via traceable mail (e.g.,, certified mail) in order to ensure that it
has been delivered and received by PES.
Once your scantron form has been received and processed by PES, you will be able to go online to a status review
page to review and amend the application where modifiable.

ACKNOWLEDGMENT OF THE RECEIPT OF THE WEB-BASED APPLICATION

If you have submitted the examination application online, you will be notified of the receipt of the application via e-
mail if you have provided PES with an e-mail address. If you did not provide PES with an e-mail address you will be
able to return online to check the status of your application on a status review page.

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CONFIRMATION OF RECEIPT OF THE OFFICIAL FINAL TRANSCRIPT AND/OR NBCOT ACADEMIC CREDENTIAL
VERIFICATION FORM
To receive acknowledgment that your transcript or ACVF has been received by PES, please provide your registrar with
a self-addressed, stamped postcard and ask that it be enclosed with the transcript or ACVF when it is mailed to PES.
Upon receipt of your transcript or ACVF, PES will mail the postcard. You may also have your registrar mail the
transcript via traceable mail. This confirms only that the transcript or ACVF has been “received”. You are encouraged
to check with your registrar to ensure that the ACVF or official final transcript contains all the information which is
required. You may also go online to the status review page to check the status of your application processing to
include the receipt of the transcript or ACVF.

CONFIRMATION OF EXAMINATION ELIGIBILITY AND COMPLETED EXAMINATION REGISTRATION

If you want to report to a state regulatory agency or an employer that you are eligible to take the certification
examination and that you have completed the examination registration process, request a Confirmation of
Examination Registration and Eligibility to Examine Notice. You may also request this notice for your records. The
notice will contain the following confirmations and information: (1) your application process is complete and you are
registered to take the examination, (2) the test site selected, (3) receipt of the official final transcript and/or the NBCOT
Academic Credential Verification Form (ACVF) and (4) your examination history since 1997, that is the dates of each
examination taken from 1997 to the present.
In order to confirm your eligibility to examine, all required documentation and fees must be received by PES and
must be in order. This notice cannot be generated until the examination application, application fees AND the official
final transcript or ACVF have been received by PES and reviewed. The fee for EACH notice is $40 and includes
mailing a copy of the notice to the candidate. Be advised that state regulatory agencies and employers prefer an
original notice sent directly from NBCOT. When the notice is sent, you will receive a copy. On your examination
application form (scantron or web-based application), indicate in the appropriate box that you are requesting a
Confirmation of Examination Registration and Eligibility to Examine Notice and indicate the jurisdictions or name
and address of other party to whom it is to be sent. Be sure to include sufficient fee(s) ($40 per notice) to cover the
number of notices requested. If you wish to have the confirmation notice sent via overnight delivery rather than
regular mail, the fee per notice is $20. Indicate that request on the examination application or on the form in the back
of this handbook

WITHDRAWALS, REFUNDS, AND ABSENCES

Any candidate eligible for any refund of the examination application fee ($325) will receive a partial refund of
$155. Any candidate eligible for any refund of the practice examination fee ($120) will receive a partial refund of
$49.00. NO full refund of the examination application fee or the practice examination fee is provided. If the
application is withdrawn, the Jurisdiction/State Reporting Fee is refundable.
The following fees are NOT refundable: Resubmission Fee ($30 per resubmission), International Test Center Fee for
March 17, 2001 examination, Non-established Test Center Fee for March 17, 2001 examination, and Expedited
Mailing Fee- overnight mail for score report or Confirmation of Examination Registration and Eligibility Notice.
If you must withdraw your examination application, you must notify PES by certified mail, return receipt requested at
least three weeks prior to the test date in order to be eligible to receive the partial refund of the examination
application fee of $155 (see page 6). An application that is not withdrawn prior to the refund deadline will forfeit the
partial refund as well. Application fees are not transferable to a future administration.
If you have chosen to take the practice examination and you do not schedule it within the allotted time frame as
indicated in your Authorization to Test Letter (ATT) or if you find that you are unable to take the practice examination
and you cancel your appointment with Prometric in the time frame indicated in your ATT letter, you are entitled to a
refund of $49.00, only. You must request this refund in writing from PES. If you fail to appear for your scheduled
practice examination appointment without proper advance notice to Prometric you will forfeit any refund and you will
not be able to reschedule your appointment. See your ATT letter for additional information.
After the refund deadline, if a medical, personal or weather-related emergency prevent you from taking the
certification examination and you wish to have NBCOT consider any extenuating circumstances in consideration of a
refund of the certification examination fee, you must submit to NBCOT a written explanation of your absence and any

17
supporting documentation, postmarked no later than thirty (30) days after the examination date. Refunds of the
certification examination application fee for emergencies are handled on a case-by-case basis by NBCOT. If your
refund request is approved you will be refunded $155 of the certification examination application fee.

ADMISSION NOTICE
If your examination registration is complete, you will receive an admission notice by mail, approximately two (2)
weeks before the test date. If you have not received an admission notice one (1) week prior to the test date, PES should
be notified by telephone at (212) 367-4389. The specific test center location and reporting time will be printed on this
notice along with your name and address. Your admission notice may provide to you the location of a check-in room.
You may be required to move to another room for the actual administration of the examination. You must present the
admission notice to be admitted to the examination. If there are any errors (e.g.,, minor spelling errors, incorrect
middle initial) in your name as printed on your admission notice, please correct them on the Change of Address Form
which is a part of your admission notice. To formally change your name on your score reports and certificates see
details regarding name change. Keep your admission notice until you have received your examination score report.

ON EXAMINATION DAY

IDENTIFICATION AT THE TEST CENTER

You must produce two (2) current forms of identification including one photo identification document with signature
at the test center. All forms of identification must be original. Copies are not accepted. The name on your
identification must match the name under which you have registered to take the examination. You will not be
admitted without the required identification. You will be required to sign the roster upon entry to the test center.
• Acceptable forms of PHOTO IDENTIFICATION WITH SIGNATURE include: driver’s license, work
identification, passport or school identification.
• Acceptable forms of OTHER (SECOND) IDENTIFICATION include: credit card, original social security card,
original school identification, or other identification with printed name and signature.

REPORTING TIME AND ADMINISTRATION TIME

The check-in period begins with registration at 8:00 a.m. and the examination administration ends at 1:00 p.m.
CANDIDATES REPORTING FOR CHECK-IN LATER THAN 8:30 A.M. WILL NOT BE ADMITTED. You have four (4)
hours to complete the examination. Once all candidates are assembled at the testing site the Chief Examiner can
begin the examination, resulting in the examination period ending before 1 PM if the four hours of administration time
have been allowed. It is recommended that you bring your own watch for pacing yourself. However, time-keeping
malfunctions on your part are not grounds for special consideration or extra time. The Chief Examiner will announce
when there are 30 minutes remaining in the testing period. If you have a disability or health impairment that requires
many breaks, you should complete the application for special accommodations (see page 47 for details).
ANSWER SHEETS
All of your answers must be recorded on the answer sheet. There is NO CREDIT for answers recorded in the test
booklet unless it has been pre-approved as a special accommodation.
SUPPLIES
The only supplies permitted for the test are sharpened No. 2 pencils and an eraser. No supplies are furnished at the
test center. Use the margins of the test booklet for scratch work if needed. The following items are NOT permitted in
the testing area: DICTIONARIES, CALCULATORS, HIGHLIGHTERS, FOOD OR DRINK OF ANY KIND (unless
approved as a special testing accommodation for medical reasons), CELL PHONES, PAGERS, BACKPACKS,
CAMERAS, RECORDING DEVICES (VIDEO OR AUDIO), EARPHONES, LARGE BAGS, LARGE PURSES, BRIEFCASES,
SCRATCH PAPER, RULERS, GUIDES, PILLOWS, CUSHIONS, or AMPLIFIERS (unless approved as a testing
accommodation). If these items are discovered they will be held until the conclusion of the examination.

HAZARDOUS WEATHER
In the event that hazardous weather prevents you from taking the test, you must notify PES by telephone at (212) 367-
4300 within three (3) days following the test date. Obtain the name of the individual with whom you spoke.
Notification by certified mail, returned receipt requested is recommended. NBCOT and PES will determine whether

18
circumstances (e.g.,, significant number of candidates affected) warrant the rescheduling of the test. Staff will be
available at PES on test dates to answer candidates’ questions. Every effort will be made to keep test centers open.

SECURITY
Only examination candidates are permitted near the testing area. The Chief Examiner will require ALL persons other
than examination candidates to leave the testing area. Upon completion of the examination, candidates must leave
the testing area immediately.
Any candidate who gives or receives assistance from another candidate during the test will be required to turn in the
test materials immediately and leave the room. Any candidate observed looking at another candidate’s test materials
will be moved and the incident will be reported to NBCOT. An investigation will be conducted and the candidate’s
score may be voided. Any candidate found to be using unauthorized materials or aids (e.g.,, dictionary, books,
articles, calculator, recording device) in the test room or anywhere in the area of and/or during the test administration
will be required to surrender examination materials and leave the premises. The candidate’s answer sheet will not be
scored and the situation will be reported to NBCOT. Candidates are not permitted to read test items aloud or talk to
each other during the administration.
The performance of all examinees on the current administration, or any previous administration is monitored,
evaluated and analyzed statistically for purposes of detecting fraud. If it is determined that a score has questionable
validity or the identity of the examination candidate is in question, NBCOT will determine whether the candidate’s
score will be released. Should there be question, at any time, after an examination administration about score validity
or the identity of an examination candidate, NBCOT will investigate and determine whether to void the examination
score and/or the candidate's certification, if necessary.

AFTER THE EXAMINATION

SCORING THE EXAMINATION

Your total raw score (the total number correct) is converted to a “scaled score.” Your results will be reported as a
scaled score, on a scale ranging from 300 to 600 points. You must obtain a scaled score of at least 450 in order to
pass the examination.

SCORE REPORTS AND CERTIFICATES

Passing candidates will receive a report of the total scaled score on the examination and an official NBCOT certificate
and wallet card. Failing candidates will receive a score report which will provide performance information for each
domain area of the examination as well as a total scaled score. This score information on the domain areas is provided
for diagnostic purposes only. If you fail the examination, you will have to re-take the entire examination. If you
remain eligible to examine you will be contacted by NBCOT to determine whether you wish to receive a handbook
and examination application for the next administration. Your application (paper or on-line access) for any subsequent
examination must be pre-approved by NBCOT before it can be submitted to PES. “Licensure Only” candidates who
fail the examination should contact their regulatory agency for approval to take a subsequent administration.
Your score report will be printed and mailed APPROXIMATELY five weeks after the test administration. If it has been
60 days since the test administration date and you have not received your score report, please notify PES in writing by
submitting the Duplicate Score Request form found in the back of this handbook. Telephone requests for a duplicate
score report are not accepted. Neither PES nor NBCOT will release score information to anyone over the telephone
or via facsimile. No candidate score identified by name is released to any party without the candidate’s written
authorization.
NBCOT reports scores (without names) of new US graduates to the US occupational therapy program from which the
candidate graduated if there are three or more candidates. If the candidate passes the examination, the name will be
reported to the program on the list of newly-certified COTAs or OTRs from the program.
Upon receipt of your score report if you hold any limited or temporary permit(s)/license(s) which allow you to
practice, you are advised to contact immediately, the regulatory agency in that jurisdiction to determine whether your
limited or temporary permit/license is still valid. The law and regulations of each jurisdiction vary in their
requirements, thus it is essential that you contact the regulatory agency directly.
If you owe any fees or documentation (e.g.,, name change document) to NBCOT or PES, your score report and/or
certificate will be held until payment and/or the documentation is received.

19
HAND SCORING
During the scoring process, all answer sheets are scanned by computer and checked for unusual responses (e.g.,,
missing or duplicate answers). Answer sheets with unusual responses are checked by hand as part of the PES quality
control process. If you fail the examination, you may request a hand scoring of your answer sheet, provided such a
request is made in writing within ninety (90) days after the test date and is accompanied by a $50 fee. After you have
received the sore report, submit the Request for Hand Scoring of Answer Sheet Form (see page 35). The results of the
hand scoring will be sent to you within three weeks of the receipt of the request. This hand scoring will be final.
NBCOT does not permit candidates to review the examination booklet, any individual examination items or answer
sheets after the examination has been administered.
NAME CHANGE
To change your name on your score report and/or certificate (e.g.,, marriage, divorce or legal name change) you must
submit official notarized or certified documentation to PES verifying that your name has been legally changed.
Photocopy the name change documentation and note on the copy “submitted for proof of name change – true copy
of original.” Provide the original and the photocopy to the notary. Have the notary “notarize” the copy. Submit the
Change of Name and/or Address Form with the documentation. If you submit name change documentation within
three (3) weeks of the examination date there will be no charge for a name change on your certificate.
(1) Within three weeks of the test administration date, any name change or correction should be sent to PES. A
notarized copy of official or certified documentation of the name must be included. Any changes or corrections
will be made to the official certificate at no charge if postmarked to PES within three weeks of the test
administration date.
(2) More than three weeks after the administration date, write to NBCOT (do not send the form from the back of this
handbook to PES). Indicate the change of name requested and include a copy of official notarized or certified
documentation of the name change. There is a fee of $20.00 for a new certificate. This fee is subject to change
without notice.
EXAMINATION CHALLENGES, COMPLAINTS AND APPEALS
A candidate may challenge the content of specific test items of the examination or file a complaint regarding the
administration of the examination by sending a letter describing the basis for the content challenge or administrative
complaint and including pertinent information. E-mailed comments will not be accepted as FORMAL challenges or
complaints. With regard to a content challenge, include as much specific wording as possible from each test item that
is being challenged. The letter of challenge or complaint must be postmarked no later than seven days after the
examination administration and sent via traceable mail/delivery- signature of receipt required (e.g.,, certified mail)
to NBCOT, not PES. Letters sent after the deadline will not be considered.
The CEDC will consider the content challenge and issue a decision before the final scoring of the examination. A
candidate may appeal a CEDC challenge decision by sending a letter describing the justification for the appeal. The
appeal must be received by NBCOT within 21 days of the candidate’s receipt of the notification of CEDC’s decision.
With regard to any complaint, NBCOT and the testing agency will investigate the complaint and respond in writing to
the candidate. A candidate may appeal the decision by sending a letter describing the justification for the appeal. This
letter of appeal must be received by NBCOT no later than 21 days after the candidate’s receipt of the notification of
NBCOT’s decision.
DISCIPLINARY ACTION
Your signature on the examination application indicates that you acknowledge and agree that you shall be subject to
NBCOT’s Procedures for Disciplinary Action. These procedures may be amended from time to time. The
Disciplinary Action procedures speak to the process for investigating and adjudicating complaints concerning persons
who are certified by NBCOT. Grounds for disciplinary action for failure to engage in the safe, proficient and/or
competent practice of occupational therapy are: (1) incompetence, (2) unethical behavior, and (3) impairment.
Possible sanctions include: (1) ineligibility for certification, (2) reprimand, (3) censure, (4) probation, (5) suspension
and (6) revocation. The complete text of NBCOT’s Procedures for Disciplinary Action is available upon request and
can also be found at the web address – www.nbcot.org.

The Certification Examinations are the exclusive property of NBCOT, Inc. No part of the examinations may be copied,
reproduced or shared in any manner, in part or whole, by any means whatsoever. The theft or attempted theft of an
examination booklet, any of its pages, or any test items by any means is punishable as a felony. Any examinee who violates
security will not have his or her examination scored.

20
Codes for Technical Level Occupational Therapy Programs for Candidates for COTA (listed alphabetically by state,
school). BE SURE YOU ARE SELECTING THE APPROPRIATE CODE FOR AN OTA PROGRAM.

SCHOOL CODES
Georgia
Alabama 11308 *Augusta Technical College (Formerly Augusta
10106 Jefferson State Community College, Birmingham, Technical Institute), Augusta
10105 Wallace State Community College, Hanceville, 11305 Darton College, Albany
Arizona 11301 Medical College of Georgia
10301 Apollo College, Tucson and Phoenix, 11302 Middle Georgia College, Cochran
Arkansas 11304 Northwestern Technical Institute, Rock Spring
10502 *South Arkansas Community College, El Dorado 11306 Southwest Georgia Technical College (Formerly
California Thomas Technical Institute), Rock Spring
10623 Andon College at Modesto, Modesto, Hawaii
10622 Fresno City College, Fresno, 11501 Kapiolani Community College, Honolulu
10616 Grossmont College, El Cajon, Idaho
10605 Loma Linda University, Loma Linda, 11601 American Institute of Health Technology, Boise
10617 Maric College, San Diego, Sioux City
10614 Mt. St. Mary’s College, Los Angeles, Illinois
10613 Sacramento City College, Sacramento, 11719 Black Hawk College, Moline
10619 Santa Ana College, Santa Ana, 11715 College of DuPage, Glen Ellyn
10620 Western Career College-San Leandro Campus, 11705 Illinois Central College, Peoria
San Leandro, 11721 Lewis & Clark Community College, Godfrey
10618 Western Institute of Science and Health, Rohnert 11720 Lincoln Land Community College, Springfield
Park 11714 Parkland College, Champaign
Colorado 11708 South Suburban College of Cook County, South
10805 Arapahoe Community College, Littleton Holland
10807 Denver Technical College, Denver, 11716 Southern Illinois Collegiate Common Market,
10806 Morgan Community College, Ft Morgan, Marion, IL (Comprised of John A. Logan, Rend
10803 Pueblo Community College, Pueblo Lake, Shawnee CC and Southeastern IL. College)
10804 Westwood College of Technology, Denver, 11711 Wright College, Chicago
Connecticut Indiana
10905 Briarwood College, Southington 11804 Ivy Tech State College - Central Indiana,
Indianapolis
10906 *Housatonic Community-Technical College,
Manchester 11808 Michiana College, Fort Wayne
10902 Manchester Community-Technical College, 11807 Michiana College, South Bend
Manchester 11809 *Professional Careers Institute, indianapolis
Delaware 11806 Saint Francis, University of, Ft. Wayne
11002 Delaware Tech and Comm. Coll., Wilmington 11805 Southern Indiana, University of, Evansville
Campus, Wilmington Iowa
11001 Delaware Tech and Community College, Owens 11902 Kirkwood Community College, Cedar Rapids
Campus, Georgetown 11904 Western Iowa Technical Community College,
Florida Kansas
11209 Central Florida Community College, Ocala 12002 Barton County Community College, Great Bend
11220 *Chipola Junior College, Marianna 12006 Kansas City Kansas Community College, Kansas
11208 Daytona Beach Community College, Daytona City
Beach Kentucky
11217 Florida Hospital College of Health Sciences, 12105 Jefferson Community College, Louisville
Orlando 12104 Madisonville Technical College
11206 Hillsborough Community College, Tampa Louisiana
11213 Keiser College, Ft. Lauderdale 12204 Delgado Community College, New Orleans
11219 Keiser College, Melbourne 12203 Northeast Louisiana University, Monroe
11215 Manatee Community College Maine
11203 Palm Beach Community College, Lake Worth 12302 Kennebec Valley Technical College, Fairfield
11218 Polk Community College, Winter Haven

21
Codes for Technical Level Occupational Therapy Programs for Candidates for COTA (listed alphabetically by state,
school). BE SURE YOU ARE SELECTING THE APPROPRIATE CODE FOR AN OTA PROGRAM.

Maryland Nebraska
12410 Allegany College of Maryland, Cumberland 13104 Clarkson College, Omaha
12409 Community College of Baltimore County at New Hampshire
Catonsville, Baltimore 13304 Hesser College, Manchester
Massachusetts 13303 New Hampshire Community Tech College-
12517 Bay Path College, Longmeadow Claremont
12518 Bay State College, Boston New Jersey
12510 Becker College, Worcester 13402 Atlantic Cape Community College, Mays
12520 Bristol Community College, Fall River Landing
12521 Greenfield Community College, Greenfield 13401 Union County College, Plainfield
12522 Lasell College, Auburndale New Mexico
12513 Massachusetts Bay Community College, 13503 Eastern New Mexico University, Roswell
Wellesley Hills 13501 Western New Mexico University, Silver City
12512 Mt. Ida College, Newton Centre Nevada
12506 North Shore Community College, Danvers 13201 Community College of Southern Nevada, West
12507 Quinsigamond Community College, Worcester Charleston Campus, Las Vegas
12516 Springfield Technical Community College, New York
Springfield 13639 Adirondack Community College, Queensbury
Michigan 13605 Erie Community College, Williamsville
12616 Baker College of Muskegon, Muskegon 13627 Genesee Community College, Batavia
12615 Charles Stewart Mott Community College, 13620 Herkimer County Community College, Herkimer
Fenton 13635 Jamestown Community College, Jamestown
12619 Davenport College, Kalamazoo 13606 LaGuardia Community College, Long Island City
12611 Grand Rapids Comm. College, Grand Rapids 13618 Maria College, Albany
12612 Lake Michigan College, Niles 13636 Mercy College, Dobbs Ferry
12617 Macomb Community College, Clinton Township 13619 Orange County Comm. College, Middletown
12606 Schoolcraft College, Garden City 13617 Rockland Community College, Suffern
12608 Wayne County Community College, Detroit 13631 Suffolk County Community College-Western
Minnesota Campus, Brentwood
12701 Anoka-Hennepin Technical College, Anoka 13638 SUNY College of Technology at Canton, Canton
12704 Lake Superior College, Duluth 13633 Touro College - Main Campus, New York
12711 Northwest Technical College, East Grand Forks, North Carolina
12713 Northwest Technical College-Bemidji, Bemidji 13703 Caldwell Community College & Tech. Institute,
12710 Riverland Community College, Austin, MN Hudson
12709 College of St. Catherine - Minneapolis, 13709 Cape Fear Community College. Wilmington
Minneapolis 13707 Durham Technical Community College, Durham
Mississippi 13705 Pitt Community College, Greenville
12804 * Holmes Community College, Ridgeland 13710 Rockingham Community College, Wentworth
12803 Pearl River Community College, Hattiesburg 13706 Southwestern Community College, Sylva
Missouri 13704 Stanly Community College, Albemarle
12913 Missouri College, St. Louis North Dakota
12904 Penn Valley Community College, Kansas City 13801 North Dakota State College of Science, Wahpeton
12909 Sanford-Brown College, Hazelwood Ohio
12911 Sanford-Brown College, Kansas City Campus, 13910 Cincinnati State Technical and Community
Kansas City College, Cincinnati
12914 * St. Charles County Community College, St. 13905 Cuyahoga Community College, Cleveland
Peters 13913 Kent State University, East Liverpool
12905 St. Louis Community College at Meramec, St. 13919 Lima Technical College, Lima
Louis 13907 Lourdes College, Sylvania
Montana 13911 Muskingum Area Technical College, Zanesville
13001 Montana State University, College of
Technology, Great Falls

22
Codes for Technical Level Occupational Therapy Programs for Candidates for COTA (listed alphabetically by state,
school). BE SURE YOU ARE SELECTING THE APPROPRIATE CODE FOR AN OTA PROGRAM.

Ohio (cont) Tennessee (cont)

13918 Owens Community College, Toledo 14703 Nashville State Technical Institute, Nashville
13909 Shawnee State University, Portsmouth 14706 Roane State Community College, Harriman
13912 Sinclair Community College, Dayton Texas
13908 Stark State College of Technology, Canton 14815 Amarillo College, Amarillo
Oklahoma 14801 Army Medical Department Center and School,
14404 Caddo-Kiowa Voc-Tech Center/Southwestern OK Ft. Sam Houston
State University, Fort Cobb 14811 Austin Community College, Austin
14002 Oklahoma City Community College, Oklahoma 14825 Del Mar College, Corpus Christi
City 14804 Houston Community College, Houston
14004 Southwestern Oklahoma State University, Fort 14827 Kingwood College, Kingwood
Cobb 14822 Laredo Community College, Laredo
14003 Tulsa Community College, Tulsa 14817 Navarro College, Corsicana
Oregon 14813 North Central Texas College, Denton
14101 Mt. Hood Community College, Gresham 14823 Panola College, Carthage
Pennsylvania 14816 San Jacinto College South, Houston
14223 Clarion University of Pennsylvania, Venango 14824 South Texas Community College, McAllen
Campus, Oil City
14807 St. Philip’s College, San Antonio
14213 Community College of Allegheny County,
14826 Tomball College, No. Harris Mont. C.C. District,
Monroeville
Tomball
14212 Harcum College, Bryn Mawr
Utah
14226 ICM School of Business and Medical Careers,
14901 Salt Lake Community College, Salt Lake City
Pittsburgh
Vermont
14203 Lehigh Carbon Comm. College, Schnecksville
15001 Champlain College, Burlington
14204 Mt. Aloysius College, Cresson
Virginia
14232 Pennsylvania State University, Berks-Lehigh
Valley Campus, Reading 15104 Coll. of Health Science, Community Hosp. of
Roanoke Valley, Roanoke
14222 Pennsylvania State University, Worthington
Scranton Campus, Dunmore 15103 J. Sargeant Reynolds Community College,
Richmond
14214 Pennsylvania College of Technology,
Williamsport 15108 Southwest Virginia Comm. College, Richlands
14215 Pennsylvania State University, Mont Alto 15109 Tidewater Community College, Virginia Beach
Campus, VA Beach
14224 Pennsylvania State University, DuBois Campus,
DuBois Washington
14220 Pennsylvania State University, Shenango 15301 Green River Community College, Auburn
Campus, Sharon 15304 Yakima Valley Community College, Yakima
Puerto Rico West Virginia
15901 Humacao University College, Humacao 15402 College of West Virginia, Beckley
Rhode Island Wisconsin
14302 Community College of Rhode island, Newport 15501 Fox Valley Technical College, Appleton
14301 New England Institute of Technology, Warwick 15503 Madison Area Technical College, Madison
South Carolina 15510 Milwaukee Area Technical College, Milwaukee
14504 Greenville Technical College, Greenville 15512 Western Wisconsin Technical College, LaCrosse
14503 Trident Technical College, Charleston 15513 Wisconsin Indianhead Technical College,
Ashland
South Dakota
Wyoming
14602 Lake Area Technical Institute, Watertown
15602 Casper College, Casper
14603 National American University, Rapid City
Tennessee
14709 Knoxville business College, Knoxville * Schools which may receive accreditation in 2000 or 2001

23
Codes for Professional Level Occupational Therapy Programs for Candidates for OTR (listed alphabetically by
state, school). BE SURE YOU ARE SELECTING THE APPROPRIATE CODE FOR AN OT PROGRAM.
Alabama
20107 Alabama State University, Montgomery
20101 Alabama, University of, Birmingham
20104 South Alabama, University of, Mobile
20103 Tuskegee University, Tuskegee
Arkansas
20501 Central Arkansas, University of, Conway
Arizona
20302 Arizonia School of Health Sciences (Kirksville
College), Phoenix
20303 Midwestern University, Glendale
California
20624 California State University, Dominguez Hills,
Carson
20621 Domincan College of San Rafael, San Rafael
20605 Loma Linda University, Loma Linda
20615 Samuel Merritt College, Oakland
20608 San Jose State University, San Jose
20609 Southern California, University of, Los Angeles
Colorado
20802 Colorado State University, Ft. Collins
Connecticut
20904 Hartford, University of, West Hartford
20903 Quinnipiac College, Hamden
District of Columbia
21101 Howard University, Washington, DC
Florida
21205 Barry University, Miami Shores
21204 Florida A & M University, Tallahassee
21216 Florida Gulf Coast University, Fort Myers
21202 Florida International University, Miami
21201 Florida, University of, Gainesville
21207 Nova Southeastern University, Ft. Lauderdale
21214 St. Augustine for Health Sciences, The U. of St.
Augustine,
Georgia
21303 Brenau University, Gainesville
21307 Columbus State University, Columbus
21301 Georgia, Medical College of, Augusta
Idaho
21602 *Idaho State University, Pocatello
Iowa
21903 St. Ambrose University, Davenport
Illinois
21712 Chicago State University, Chicago
21718 Governors State University, University Park
21706 Illinois at Chicago, University of, Chicago
21717 Midwestern University, Downers Grove
21713 Rush University, Chicago
Indiana
21801 Indiana University School of Medicine,
Indianapolis
Indiana (cont)
21802 Indianapolis, University of, Indianapolis
21803 Southern Indiana, University of, Evansville
Kansas
22001 Kansas, University of, Kansas City
22004 Newman University, Wichita
Kentucky
22102 Eastern Kentucky University, Richmond
22103 Spalding University, Louisville
Louisiana
22202 Louisiana State University Medical Ctr., New
Orleans and Shreveport
22203 Northeast Louisiana University, Monroe
Maine
22303 Lewiston-Auburn College, U. of Southern Maine,
Lewiston
22301 New England, University of, Biddeford
Maryland
22408 Towson University, Towson
22411 Western Maryland Area Health Education Center,
Towson
Massachusetts
22519 American International College, Springfield
22523 Bay Path College, Longmeadow
22502 Boston University, Sargent College of Health and
Rehab Sciences, Boston
22514 Springfield College, Springfield
22509 Tufts University-BSOT, Medford
22511 Worcester State College, Worcester
Michigan
22613 Baker College of Flint, Flint
22601 Eastern Michigan University, Ypsilanti
22618 Grand Valley State University, Allendale
22614 Saginaw Valley State University, University Center
22609 Wayne State University, Detroit
22610 Western Michigan University, Kalamazoo
Minnesota
22707 Minnesota, University of, Minneapolis
22712 Saint Scholastica, The College of, Duluth
22708 St. Catherine - St. Paul, Coll. of, St. Paul
(Consortium of the Coll. of St. Thomas)
Mississippi
22802 Mississippi Medical Center, University of, Jackson
Missouri
22912 Maryville University, St. Louis
22901 Missouri-Columbia, University of, Columbia
22906 Rockhurst College, Kansas City
22907 St. Louis, St. Louis
22902 Washington University, St. Louis
Nebraska
23102 Creighton University, Omaha
23103 College of St. Mary, Omaha

24
Codes for Professional Level Occupational Therapy Programs for Candidates for OTR (listed alphabetically by
state, school). BE SURE YOU ARE SELECTING THE APPROPRIATE CODE FOR AN OT PROGRAM.
New Hampshire
23302 New Hampshire, University of, Durham
New Jersey
23403 Kean University, Union
23405 *Richard Stockton College of New Jersey, Pomona
23404 Seton Hall University
New Mexico
23502 New Mexico, University of, Albuquerque
New York
23610 Brooklyn, SUNY, University of, Brooklyn
(Downstate)
23609 Buffalo, SUNY, University of, Buffalo
23604 Columbia University, New York
23623 D’Youville College, Buffalo
23622 Dominican College, Orangeburg
23630 Ithaca College, Ithaca
23624 Keuka College, Keuka Park
23629 Mercy College, Dobbs Ferry
23628 New York at Stony Brook, State U. of, Stony Brook
23634 New York Institute of Technology, Old Westbury
23611 New York University, New York
23626 Sage Colleges, Troy
23632 Touro College - Main Campus, New York City
23625 Touro College, Bay Shore
23615 Utica College of Syracuse University, Utica
23616 York College of CUNY, Jamaica
North Carolina
23701 East Carolina University, Greenville
23708 Lenoir-Rhyne College, Hickory
23702 North Carolina, University of, Chapel Hill
23711 Winston-Salem State University, Winston-Salem
North Dakota
23803 Mary, University of, Bismarck
23802 North Dakota, University of, Grand Forks
Ohio
23903 Cleveland State University, Cleveland
23916 Findlay, The University of, Findlay
23914 Ohio at Toledo, Medical College of, Toledo
23906 Ohio State University, Columbus
23917 Shawnee State University, Portsmouth
23915 Xavier University, Cincinnati
Oklahoma
24001 Oklahoma Health Sciences Center, U.
Oklahoma City
Oregon
24103 Pacific University, Forest Grove
Pennsylvania
24221 Alvernia College, Reading
24219 Chatham College, Pittsburgh
24216 Duquesne University, Pittsburgh
24202 Elizabethtown College, Elizabethtown
Pennsylvania (cont)
24218 Gannon University, Erie
24209 Misericordia, College, Dallas
24225 Mt. Aloysius College, Cresson
24228 Pennsylvania State University, The, Mont Alto
24210 Pittsburgh, University of, Pittsburgh
24230 *Philadelphia University (formerly Philadelphia
College - College of Textiles and Science),
Philadelphia
24229 Saint Francis College, Loretto
24227 Sciences in Philadelphia, University of the,
Philadelphia
24217 Scranton, University of, Scranton
24207 Temple University, Philadelphia
24211 Thomas Jefferson University, Philadelphia
Puerto Rico
25904 Puerto Rico, University of, San Juan
South Carolina
24502 South Carolina, Medical U. of, Charleston
South Dakota
24601 South Dakota, University of, Vermillion
Tennessee
24707 Belmont University, Nashville
24708 Milligan College, Milligan
24705 Tennessee State University, Nashville
24704 Tennessee, University of, Memphis
24710 Tennessee, University of, at Chattanooga
Texas
24818 Texas at El Paso, University of, El Paso
24810 Texas Health Science Center, University of, San
Antonio
24821 Texas Pan-American, U. of, Edinburg
24808 Texas School of AHS at Galveston, U. of,
Galveston
24819 Texas Tech Univ. HSC Regional AHC at Amarillo,
Amarillo
24820 Texas Tech Univ. HSC Regional AHC of the
Permian Basin, Odessa
24812 Texas Tech University Health Sciences Center,
Lubbock
24809 Texas Woman’s University, Denton, Dallas and
Houston
Virginia
25110 College of Health Sciences, Roanoke
of, 25111 James Madison University, Harrisonburg
25105 Shenandoah University, Winchester
25102 Virginia Commonwealth University, Richmond
Washington
25302 Puget Sound, University of, Tacoma
25303 Washington, University of, Seattle
West Virginia
25401 West Virginia University, Morgantow
25
Codes for Professional Level Occupational Therapy Programs for Candidates for OTR (listed alphabetically by
state, school). BE SURE YOU ARE SELECTING THE APPROPRIATE CODE FOR AN OT PROGRAM.
Wisconsin Wyoming
25511 Concordia University Wisconsin, Mequon 25601 Casper College, Casper
22505 Mount Mary College, Milwaukee SCOTLAND
25514 Wisconsin-LaCrosse, University of, LaCrosse 28001 Queen Margaret University College, Edinburgh
25508 Wisconsin-Madison, U. of, Madison
25509 Wisconsin-Milwaukee, U. of, Milwaukee *Schools that may receive accreditation in 2000 or 2001

EXAMINATION CONTENT
Each examination (COTA and OTR) consists of 200 items that use the four-option, multiple-choice format. There is
only one correct response/answer for each item. All items are equal in weight. No combination answers, such as "All
of the Above", or "A and B" are used. It is to your advantage to answer every examination item as there is no penalty
for incorrect or omitted answers.
NBCOT’s practice analysis, National Study of Occupational Therapy Practice, provides the basis for the certification
examination templates. Each outline (COTA and OTR) for the examination is based upon seven domains (i.e., tasks
that the COTA does for the COTA examination or the tasks that the OTR does for the OTR examination), the content
areas content areas (knowledge and skills) and the percentage weight for each domain. It is important for you to
review each of the domains as you prepare for the examination. The approximate weighting of each domain
including the number of items is based upon the exam specifications. It is important to remember that the
examinations are based upon outlines that describe the occupational therapy process; they are not organized around
diagnostic groups or practice settings.

COTA EXAMINATION OUTLINE

DOMAIN (The tasks a COTA must know how to do.) Approx. % of Items
A. Determine needs and priorities for intervention, based upon an 16%
appreciation and understanding of the individual as an occupational
being
B. Identify and/or design theoretically based interventions that address the 15%
individual’s occupational needs
C. Implement interventions, using current practices and emerging 45%
knowledge
D. Report and evaluate effectiveness of interventions 12%
E. Provide occupational therapy services that address the occupational 5%
needs of populations within the context of their physical, social, and
cultural environments
F. Manage the delivery of occupational therapy services 5%
G. Advance the effectiveness of the profession of occupational therapy 2%

(Domains F and G are combined for score reporting.)

COTA EXAMINATION CONTENT AREAS
A. Human development and performance
Knowledge and skills related to:
1. individual’s evolution and skill development in the context of their lives (including expected
patterns/progressions associated with traumatic and/or pathological conditions)
2. the impact of physical, social, and cultural contexts on a development across the life span

26
COTA EXAMINATION Content Areas (CONT.)
B. Principles and strategies in the identification/evaluation of strengths and needs
Knowledge and skills related to:
1. interview, observation, activity analysis, and other data-gathering techniques
2. assessments interpreting results
C. Principles and strategies in intervention/treatment planning
Knowledge and skills related to:
1. components of the intervention plan
2. conceptual frameworks (that is, frame of reference)
3. goal-setting
4. criteria for selecting interventions

D. Principles and strategies in intervention

Knowledge and skills related to:
1. intervention techniques, modalities, and activities
2. monitoring and assessing progress
3. discharge planning

E. The nature of occupation and occupational performance

Knowledge and skills related to:
1. the factors that comprise occupation
2. how individuals engage in and perform occupations in their daily lives

F. Service management
Knowledge and skills related to:
1. service delivery systems
2. service management (program planning and development, outcomes assessment
3. human, financial, and material resource management
G. Responsibilities as professional
Knowledge and skills related to:
1. occupational therapy roles, code of ethics, and standards of practice
2. federal, state, and local regulations governing occupational therapy practice

OTR EXAMINATION OUTLINE

DOMAIN (The tasks an OTR must know how to do.) Approx. % of items
A. Determine needs and priorities for intervention, based upon an 22%
appreciation and understanding of the individual as an occupational being
B. Identify and/or design theoretically based interventions that address the 14%
individual’s occupational needs
C. Implement interventions, using current practices and emerging knowledge 37%
D. Report and evaluate effectiveness of interventions 11%
E. Provide occupational therapy services that address the occupational needs 4%
of populations within the context of their physical, social, and cultural
environments
F. Manage the delivery of occupational therapy services 9%
G. Advance the effectiveness of the profession of occupational therapy- 3%

(Domains F and G are combined for score reporting.)

27
OTR EXAMINATION CONTENT AREAS
A. Human development and performance
Knowledge and skills related to:
1) individual’s evolution and skill development in the context of
2) their lives (including expected patterns/progressions associated with traumatic and/or pathological
conditions)
3) the impact of physical, social, and cultural contexts on a development across the life span
B. Principles and strategies in the identification/evaluation of strengths and needs
Knowledge and skills related to:
1) interview, observation, activity analysis, and other data-gathering techniques
2) assessments
3) interpreting results
C. Principles and strategies in intervention/treatment planning
Knowledge and skills related to:
1) components of the intervention plan
2) conceptual frameworks (that is, frame of reference)
3) goal-setting
4) criteria for selecting interventions
D. Principles and strategies in intervention
Knowledge and skills related to:
1) intervention techniques, modalities, and activities
2) monitoring and evaluating progress
3) discharge planning
E. The nature of occupation and occupational performance
Knowledge and skills related to:
1) the factors that comprise occupation
2) how individuals engage in and perform occupations in their daily lives
F. Service management
Knowledge and skills related to:
1) service delivery systems
2) service management (program planning and development,
3) outcomes assessment)
4) human, financial, and material resource management
G. Responsibilities as professional
Knowledge and skills related to:
1) occupational therapy roles, code of ethics, and standards of practice
2) federal, state, and local regulations governing occupational therapy practice

28
 NBCOT Certification Examination
Instructions for the Completion of the NBCOT Academic Credential Verification Form
(SHARE THESE INSTRUCTIONS WITH YOUR REGISTRAR WHEN REQUESTING THE COMPLETION OF THE ACVF.)
TO THE CANDIDATE:
1. Please use this form to provide information supplemental to the transcript which is needed to confirm your eligibility to
examine. You may also use this form (to confirm your eligibility and gain admission to the examination) in lieu of the
submission of the official final transcript should you not be able to provide an official final transcript by the deadline
indicated (postmarked no later than February 15, 2001 for the March 2001 examination or postmarked no later than June 15,
2001 for the July 2001 examination). See page 5 of this handbook for further details about the use of the form.
2. The form is to be sent to Professional Examination Service (PES) by the deadline date noted above. Forms postmarked after
the deadline will not be processed. If your eligibility cannot be confirmed you will not be admitted to the examination.
3. Provide the information requested on the front page of the NBCOT Academic Credential Verification Form of this handbook.
4. Forward the form to your registrar for completion of the back page of the form.
5. As a reminder, the registrar is to send the form in a sealed envelope directly to Professional Examination Service. The
postmark deadline for the submission of the form is February 15, 2001 for the March 17, 2001 examination and June 15,
2001 for the July 21, 2001 examination.
6. Please share the instructions below with your registrar to ensure that the form is completed correctly and submitted by the
deadline.
TO THE REGISTRAR
1. Please provide the information requested on the reverse of the NBCOT Academic Credential Verification Form. Letters
submitted in lieu of this form will not be accepted.
2. This form is being completed to provide information necessary to confirm the candidate's eligibility to take the certification
examination.
3. The candidate may request that this form be completed in lieu of the submission of the official final transcript in order to
gain admission to the certification examination. The candidate may also request that this form be submitted WITH the
transcript to provide information missing from the transcript which is necessary to confirm the candidate's eligibility to
examine.
4. Please check only one box in Section A, Section B and Section C. The form is not complete unless one box in each section
has been checked. If the form is incomplete but the candidate is in fact eligible, that eligibility cannot be confirmed and
the candidate will not be admitted to the examination.
5. For Section A. Graduation: In order to be eligible to take the certification examination the candidate must have been
awarded the degree/certificate or have been cleared for graduation prior to the administration of the examination (March 17,
2001 or July 21, 2001). Cleared for graduation means that the candidate has met ALL requirements for the
degree/certificate, all grades are in, there are no outstanding financial obligations to the institution and all that remains is
the formal awarding of the degree/certificate and/or participation in graduation exercises. Graduation is CERTAIN. The
deadlines for the submission of this form by the registrar are a postmark date of February 15, 2001 for the March 17, 2000
examination and a postmark date of June 15, 2001 for the July 21, 2001 examination. If on or before February 15, 2001 (for
the March 2001 examination) or on or before June 15, 2001 (for the July 2001 examination) you are able to certify that the
candidate has been awarded the degree or has been “cleared for graduation” (graduation is certain before the examination
administration dates noted above and you can confirm that as of the date the form is signed), please check the first box in
Section A and indicate the graduation date. If the candidate cannot be cleared for graduation (graduation is NOT certain as
of the postmark deadline for the submission of the ACVF), please check the second box in Section A.
6. For Section B. Academic Credential: Please indicate the degree/certificate that the candidate has been/will be awarded.
Check only one.
7. For Section C. Major: Please indicate the candidate's major. Only candidates with majors in occupational therapy or
occupational therapy assistant are eligible to examine.
8. Please submit the form in a sealed envelope directly to:
Professional Examination Service
NBCOT Testing Office
111 8th Avenue, Room 526
New York, NY 10011-5290
9. In order to gain admission to the certification examination, the form must be postmarked to the above address no later than
February 15, 2001 for the March 17, 2001 examination and June 15, 2001 for the July 21, 2001 examination. Forms
submitted after the postmark date will not be processed, resulting in the candidate's inability to gain entrance to the
certification examination.
10. Please direct any questions about the ACVF to NBCOT at 301-990-7979, extension 3122.

29
30
 NBCOT ACADEMIC CREDENTIAL VERIFICATION FORM
Year 2001 (March/July) Certification Examinations

Return to: PES, NBCOT Testing Office, 111 8th Avenue, Room 526, New York, NY 10011-5290

TO BE COMPLETED BY CANDIDATE (FROM A U.S. PROGRAM)

In the spaces below, PRINT (use pencil or ink) your first, middle and last names. Please make sure that you use
exactly the same name used on your scannable NBCOT examination application form. Sign and date at the bottom
in ink.

1a. First Name ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

1b. Middle Name ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

1c. Last Name ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

2. Social Security Number ___ ___ ___ - ___ ___ - ___ ___ ___ ___

3. Daytime Phone Number ___ ___ ___ - ___ ___ ___ - ___ ___ ___ ___

4. School Code ___ ___ ___ ___ ___

5. Student ID Number ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

6. Exam Level you are eligible to take (check ONLY one) ____ COTA ____ OTR

7. Examination Date: ___ ___ / ___ ___ / 2001

month day
Please date and sign this form before forwarding it to the Registrar's Office. If you do NOT complete items 1
through 7, date and sign this form, your application will be rejected and returned to you.

I (the candidate) declare that the information provided by me on this form is correct.

Candidate Signature:________________________________________________________

Date: ____________________

(PLEASE SIGN IN INK)

REGISTRAR: PLEASE COMPLETE THE BACK OF THIS FORM

(047) NBCOT Academic Credential Verification Form side 1 of 2

31
 NBCOT ACADEMIC CREDENTIAL VERIFICATION FORM
YEAR 2001 (MARCH/JULY) CERTIFICATION EXAMINATIONS
TO BE COMPLETED BY THE INSTITUTION'S REGISTRAR ONLY
TO REGISTRAR: POSTMARK TO PES BY 2/15/2001 FOR THE 3/2001 EXAM OR 6/15/2001 FOR THE 7/2001 EXAM
NAME OF INSTITUTION:____________________________________________________________________
PLEASE MARK ONLY ONE BOX IN EACH SECTION (A, B AND C) BELOW. IF APPLICABLE, PLEASE PROVIDE
GRADUATION DATE IN SECTION A.

A. GRADUATION
_____I certify that the individual identified on the front of this form has been awarded the degree/certificate indicated
below OR as of this date of my signature below, is “cleared for graduation” (graduation is CERTAIN), having met
ALL requirements for the degree/certificate, all grades are in, and there are no outstanding financial obligations to
this institution. (To be eligible, the candidate’s graduation must be “CERTAIN” as of 02/15/01 for the March 2001
examination or 06/15/01 for the July 2001 examination.) The degree/certificate has been/will be awarded on:
GRADUATION DATE: ___ ___ / ___ ___ / ___ ___ ___ ___
month day year
_____The individual cannot be cleared for graduation at this time. ALL requirements for the degree/ certificate have
not been met, all grades are not in and/or the individual has outstanding financial obligations to the institution.

B. ACADEMIC CREDENTIAL:
The candidate has been or will be awarded the following:
1. UNDERGRADUATE CERTIFICATE:
____ Certificate (undergraduate) ____ Comprehensive Certificate (from undergraduate program)
ASSOCIATE DEGREE:
____ Associate Arts Degree ____ Associate Science
____ Associate Arts in Science ____ Other Associate Degree - Specify________________________
3. BACCALAUREATE DEGREE:
____ Bachelor of Arts ______ Bachelor of Science _______ Other Bachelor Degree – Specify __________
4. MASTER'S DEGREE:
____ Entry-Level Occupational Therapy Master's Degree
____ Other Master's Degree (Advanced Master's Degree awarded to an individual already possessing a
bachelor's degree or certificate in OT)
5. POST-BACCALAUREATE CERTIFICATE:
____ Post-Baccalaureate Certificate ____ Certificate in Partial Fulfillment of the Master's Degree
6. COMBINED DEGREE:
____ Combined Baccalaureate/Master's Degree
7. OTHER DEGREE/CERTIFICATE:
____ Other Degree/Certificate - Specify _________________________________________________________
C. MAJOR:
___Occupational Therapy ___Occupational Therapy Assistant ___Other: Specify:_______________________
(no major in OT or OTA)
Return to: PES, NBCOT Testing Office, 111 8th Avenue, Room 526, New York, NY 10011-5290.
Please direct any questions about the completion of this form to NBCOT at 301-990-7979, ext. 3122.
IN WITNESS WHEREOF, I hereby set my hand and seal of this institution this _____day of ______(month)
________ (year).
Registrar:______________________________________________AFFIX REGISTRAR'S SEAL/STAMP.
(047) NBCOT Academic Credential Verification Form (side 2 of 2)

32
 NATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY, INC. (NBCOT)
CHANGE OF NAME AND/OR ADDRESS

Directions: Use this form to request a change of NAME or ADDRESS before the exam or up to three weeks after the
exam. If you are requesting a name change more than three weeks after the exam, follow the instructions on page
20. Please PRINT or TYPE. Be sure to provide all information or your request cannot be processed. In order to
ensure that you receive timely correspondence or communication such as your admission notice or score report you
should maintain an accurate address. A change of name must be accompanied by a “notarized” copy of the
official/legal documentation that changes your name (e.g.,, photocopy the marriage license and have the copy
notarized) or your request cannot be honored (see page 20).

SEND TO: Professional Examination Service

NBCOT Testing Office
111 8tthAvenue, Room 526
New York, NY 10011-5290

REQUEST FOR (CHECK ALL THAT APPLY) : ______NAME CHANGE

______ADDRESS CHANGE

Please complete the following with your CURRENT information. (Please PRINT or TYPE):

Current Name
Current Street
Current City, State, Zip Code,
Country
Social Security Number/ ID#
Daytime Telephone Number
w/ area code
School Code
Examination Date
Examination Level

Please provide your previous name/address:

Previous Name
Previous Street
Previous City, State, Zip
Code, Country
Daytime Telephone Number
with area code

Candidate’s Signature
_________________________________________Date__________________________

33
34
 NATIONAL BOARD FOR CETIFICATION IN OCCUPATIONAL THERAPY, INC. (NBCOT)
REQUEST FOR HAND SCORING OF ANSWER SHEET

Do NOT submit this form until you have received your examination score report.

Directions: Use this form to request that Professional Examination Service (PES) hand score your scannable examination answer
sheet. This request must be received with proper fees and information no later than 90 days after the test date. Please PRINT or
TYPE all information. You will be notified of any change in your score.

The fee for hand scoring is $50.00. Please complete the credit card authorization or enclose a certified check or money order,
only, made payable in US dollars to PES.

Send To: Professional Examination Service

NBCOT Testing Office
111 8th Avenue, Room 526
New York, NY 10011-5290

Please complete the following with your CURRENT information. (Please PRINT or TYPE):
Name
Street
City, State, Zip Code, Country
Social Security Number/ ID#
Daytime Telephone Number w/ area code
School Code
Examination Date ____March 17, 2001
____July 21, 2001
Examination Level ____OTR
____COTA

If the above information is different from that provided when you your were tested, please complete below with the OLD
information submitted at the time you were tested:
Name
Street
City, State, Zip Code, Country
Daytime Telephone Number w/ area code

I hereby request PES to hand score my answer sheet. I have completed the credit card authorization below or I have enclosed
the $50 hand scoring fee (certified check or money order, only).

Candidate’s Signature __________________________________________ Date ________________________

CREDIT CARD AUTHORIZATION

I authorize PES to charge my account below for a total of $50.00 for hand scoring my answer sheet.

Credit Card Number : ___Visa ___ MasterCard

Expiration Date: ___ ___/ ___ ___ Signature : ____________________________________________________ (mo) (year)
Signature to authorize credit card charge

35
36
 NATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY, INC. (NBCOT)
INTERSTATE REPORTING SERVICE OFFICIAL SCORE TRANSFER REQUEST

Directions: Use this form to request Professional Examination Service (PES) to send an official copy of your examination results to
a state regulatory agency. Please PRINT or TYPE. Be sure to provide all of the information and include the required fee(s) or the
request cannot be honored. For 2001 the following jurisdictions do not accept scores from PES: Alaska, California, Hawaii,
Idaho, New Jersey and Wisconsin. You will need to contact these jurisdictions to determine their requirements.

The fee is $20.00 for each state (jurisdiction) specified. Please complete the credit card authorization or enclose a certified
check or money order, only, made payable to PES.

Send To: Professional Examination Service

NBCOT Testing Office
111 8th Avenue, Room 526
New York, NY 10011-5290

Please complete the following with your current name and address:
Name
Street
City, State, Zip Code, Country
Social Security Number/ ID#
Daytime Telephone Number w/ area code
School Code
Examination Date
Examination Level

If the above information is different from that provided at the time you were tested, please complete below with the OLD
information you provided at the time of testing:
Name
Street
City, State, Zip Code, Country
Daytime Telephone Number w/ area code
Jurisdiction(s) to which score should be sent @ $20.00 per jurisdiction:
1. 4.
2 5
3 6.

I hereby authorize PES to send an official copy of my examination score to the regulatory agency of the jurisdiction(s) listed
above. I have completed the credit card authorization below or enclosed appropriate fee(s).

Candidate’s Signature___________________________________________ Date ____________________________

CREDIT CARD AUTHORIZATION
I authorize PES to charge my account below for a total of $ _______ ($20 per score report) for sending an official copy of my
examination score report to the regulatory agency of the jurisdiction(s) listed above.

Credit Card Number : ___Visa ___ MasterCard

Expiration Date: ___ ___/ ___ ___ Signature : ____________________________________________________

(mo) (year) Signature to authorize credit card charge

37
38
 NATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY, INC. (NBCOT)
REQUEST FOR EXPEDITED MAILING OF SCORE REPORT
Directions: Use this form to request Professional Examination Service (PES) to mail your examination score report
via expedited mail. Please PRINT or TYPE. Be sure to provide all of the information and include the required fee(s)
or the request cannot be honored. This service is to US addresses only. International and Puerto Rico addresses
cannot be served.

The fee is $20.00 for overnight mail. Please complete the credit card authorization or enclose a certified check or
money order, only, made payable to PES.

Send To: Professional Examination Service

NBCOT Testing Office
111 8th Avenue, Room 526
New York, NY 10011-5290

Please complete the following with your current name and address:
Name
Street
City, State, Zip Code,
Country
Social Security Number/ ID#
Daytime Telephone Number
w/ area code
School Code
Examination Date
Examination Level

If the above information is different from that provided at the time you were applied, please complete
below with the OLD information.
Name
Street
City, State, Zip Code,
Country
Daytime Telephone Number
w/ area code

Candidate’s Signature___________________________________________Date ______________________________

CREDIT CARD AUTHORIZATION

I authorize PES to charge my account below for a total of $20.00 for sending an expedited copy my examination
score to me at the address above.

Credit Card Number : ___Visa ___ MasterCard

Expiration Date: ___ ___/ ___ ___ Signature : ____________________________________________________

(mo) (year) Signature to authorize credit card charge

39
40
 NATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY, INC. (NBCOT)
DUPLICATE SCORE REPORT REQUEST

Directions: Use this form to request Professional Examination Service (PES) to send a duplicate score report to you if
it is more than sixty (60) days after an examination administration and you have not received your score report. No
request for a duplicate score report can be honored within the first sixty (60) days after an examination
administration. After ninety (90) days (postmarked) the fee for a duplicate report is $20.00. Please PRINT or TYPE
all information. Be sure to provide all information and include the $20.00 fee or your request cannot be honored.
Enclose the credit card authorization or a certified check or money order, state/federal agency check or
corporate/company check (no other forms of payment accepted) made payable to PES.

Send To: Professional Examination Service

NBCOT Testing Office
111 8th Avenue, Room 526
New York, NY 10011-5290

Please complete the following with your CURRENT information. (Please PRINT or TYPE):

Name
Street
City, State, Zip, Country
Social Security Number/ ID#
Daytime Telephone Number w/
area code
School Code
Examination Date
Examination Level

If the above information is different from that submitted at the time your were tested, please complete below
with the OLD information submitted at the time you were tested:

Name
Street
City, State, Zip, Country
Social Security Number/ ID#
Daytime Telephone Number w/
area code
School Code
Examination Date
Examination Level

I hereby request PES to me, at the address above, a duplicate score report. The $20 fee (certified check or money
order) is enclosed or I have completed the credit card authorization.

Candidate’s Signature ______________________________________________________Date __________________

CREDIT CARD AUTHORIZATION

I authorize PES to charge my account below for a total of $ 20 for a duplicate score report.

Credit Card Number : ___Visa ___ MasterCard

Expiration Date: ___ ___/ ___ ___ Signature : ____________________________________________________

(mo) (year) Signature to authorize credit card charge

41
42
 NATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY, INC. (NBCOT)
REQUEST FOR CONFIRMATION OF EXAMINATION REGISTRATION AND ELIGIBILITY TO EXAMINE NOTICE

Directions: Use this form to request NBCOT to confirm your completed examination registration and eligibility to
take the examination for OCCUPATIONAL THERAPIST REGISTERED OTR ® or CERTIFIED OCCUPATIONAL
THERAPY ASSISTANT COTA ® to a regulatory board, an employer or for your records. The notice will contain the
following confirmations: (1) your application process is complete and you are registered to take the examination, (2)
the test site selected, (3) receipt of the official transcript and/or NBCOT Academic Credential Verification Form and
(4) examination history - a listing of the dates of examinations taken from 1997 to date. In order to confirm your
eligibility to examine and generate this notice, the examination application, required fees and the transcript and/or
Academic Credential Verification Form (ACVF) must be received by PES and be complete. The fee for EACH
notice is $40 and includes mailing a copy of the notice to the individual making the request. Please complete the
credit card authorization or enclose a check or money order for $40 per request, made payable in US dollars to
PES. There is a $30 fee for any returned check (e.g.,, insufficient funds). Make additional copies of this form for
future use or for multiple requests. If you wish expedited mailing of this notice please include sufficient fee ($20) per
notice to cover this service. Your copy will be mailed via regular mail.

CREDIT CARD AUTHORIZATION

I authorize PES to charge my account below for a total of $______($40 per notice) for sending the Confirmation of
Examination Registration and Eligibility to Examine Notice to the addresses noted. I authorize the charge of $_____
($20) per notice to receive expedited mailing.

____ Visa ____ MasterCard Total charge $_______ ( # of notices= ____, # mailed expedited = ____)

Credit Card Number :

Expiration Date: ___ ___/ ___ ___ Signature : ____________________________________________________

(mo) (year) Signature to authorize credit card charge

Send To: Professional Examination Service

NBCOT testing Office
111 8th Avenue, Room 526
New York, NY 10011-5290

Please complete the following with your CURRENT information. (Please PRINT or TYPE):
Name
Street
City, State, Zip Code, Country
Social Security Number/ ID#
Day Phone No. w/ area code
School Code
Examination Date
Examination Level

Please send a “Confirmation of Examination Registration and Eligibility to Examine Notice” to the following:
Name
Street
City, State, Zip Code, Country
Expedited Mailing _____ YES _____ NO ($20 per notice)
(Attach additional sheets if needed for multiple notices.)

I hereby request NBCOT to send a “Confirmation of Examination Registration and Eligibility to Examine Notice”
to the addressee(s) above/attached. I have enclosed the appropriate fee(s).
Candidate’s Signature _________________________________________________________ Date_________________

43
44
 NATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY, INC. (NBCOT)
APPLICATION FOR COMPUTER-BASED PRACTICE EXAMINATION

Directions: If you have already submitted your application for the certification examination and wish to take the
optional practice examination please submit this form. Please PRINT or TYPE. Be sure to provide all of the
information and include the required fee or the request cannot be honored. The postmark deadline for applying to
take the practice examination prior to the March 2001 certification examination administration is February 9,
2001. The deadline for applying prior to the July 2001 certification examination administration is June 1, 2001.

The fee is $120. Please complete the credit card authorization or enclose a certified check or money order, only,
made payable to PES.

Send To: Professional Examination Service

NBCOT Testing Office
111 8th Avenue, Room 526
New York, NY 10011-5290

Please complete the following with your current name and address:

Name
Street
City, State, Zip Code, Country
Social Security Number/ ID#
Daytime Telephone Number w/
area code
School Code
Practice Examination Level

_____ I am requesting Special Accommodations for the NBCOT certification practice examination.

You must have submitted to NBCOT the required documentation for special accommodations on the certification
examination (submission deadline January 12, 2001 for the March 2001 exam and May 1 for the July 2001 exam) if
you wish accommodations on the practice examination (see page 49). If you have not done so or did not indicate
your accommodation request for the practice examination on your special accommodations application, please
complete the Application for Special Testing Accommodations for Candidates with Disabilities and send it along
with supporting documentation to NBCOT at the time you submit this form to PES. You must meet the deadline for
requesting accommodations on the certification examination. Accommodations which are approved for the four-
hour, paper-and-pencil certification examination may not be appropriate or may be modified for the computerized
practice examination.

CREDIT CARD AUTHORIZATION

I authorize PES to charge my account below for a total of $ 120 for this Practice Examination application.

Credit Card Number : ___Visa ___ MasterCard

Expiration Date: ___ ___/ ___ ___ Signature : ____________________________________________________

(mo) (year) Signature to authorize credit card charge

45
46
 NBCOT CERTIFICATION EXAMINATION

APPLICATION FOR SPECIAL TESTING ACCOMMODATIONS FOR CANDIDATES WITH DISABILITIES

INSTRUCTIONS TO PROFESSIONALS

These instructions are provided to assist the professional with the completion of the Application for Special Testing
Accommodations. Candidates are advised to review them carefully and share them with the professional
completing the application.
INFORMATION ABOUT THE CERTIFICATION EXAMINATION AND STANDARD CONDITIONS

The occupational therapy certification examinations are four-hour multiple-choice examinations. There are no breaks
during the four-hour period. Candidates may turn in their test materials in order to leave the testing room to use the
restroom, but no adjustment to the four-hour administration time is made. Candidates are required to record their
answers on a scantron sheet (computer readable scan sheet) by filling in the bubble corresponding to their selected
answer. The candidate is tested in a room with other candidates. The number of candidates tested together may
vary depending on the number registered and the test site. All test administrations are monitored by a Chief
Examiner and proctors with sufficient numbers of personnel assigned to a test site to ensure the monitoring of
candidates in appropriate and manageable ratios. Candidates are not permitted to talk or read aloud.

• The optional practice examination is a computer-delivered, two-hour, 100 item multiple-choice examination
whose answers are recorded by mouse and/or keyboard.

APPLICATION FOR SPECIAL TESTING ACCOMMODATIONS

• This Application for Special Testing Accommodations is used to verify the existence of a diagnosed disability
(physical or mental) that substantially limits one or more major life activities (e.g.,, visual, orthopedic, speech or
hearing impairment, other health/physical impairment, a psychological or mental disorder or multiple
disabilities) therefore resulting in the candidate's need for modification (e.g.,, extra time, reader) to the standard
testing conditions. The professional who completes the application is also making testing recommendations for
the candidate on either the national certification examination and/or the optional computer-delivered practice
examination (if the candidate has elected to take the practice examination). The Application for Special Testing
Accommodations MUST be submitted at the time the candidate submits the application for the certification
examination, if the candidate is requesting special testing accommodations. The Application for Special Testing
Accommodations is sent to NBCOT, not PES. All forms and documentation are confidential and cannot be
released to anyone without the written consent of the candidate. A letter from the professional may not be
submitted in lieu of the special testing accommodations application form.

TO THE PROFESSIONAL COMPLETING THE FORM

• You MUST be a licensed or an otherwise qualified professional whose credentials are appropriate to diagnose
and evaluate the candidate's disability.
• You are asked to make testing recommendations that are reasonable and appropriate for the candidate's
disability. Your recommended accommodations should not fundamentally alter the measurement of the
knowledge and skills which the examination is intended to assess. Your recommendations are considered, they
are not binding.
• You MUST have diagnosed, treated/evaluated or consulted with the candidate within the last five (5) years and
you must have knowledge of the candidate's current functioning with the disability. The accommodations you
recommend are based on your professional knowledge of the candidate and the candidate's disability.
• You and the candidate should consult and you both should come to agreement as to the appropriate and
reasonable accommodation(s) needed for the examination.

47
• If the candidate received no testing accommodations during higher education, please be sure to provide an
explanation as to why accommodation is being requested now for this examination. Attach an additional sheet
to the accommodations application.
• Please PRINT or TYPE your responses to the items on the form.

With respect to candidates with mental (psychological/psychiatric) disorders/disabilities, especially learning

disabilities . . .

• You MUST enclose with the special testing accommodations application, copies of comprehensive
reports/evaluations/assessments (e.g.,, psychological report, psychoeducational assessment report,
neuropsychological evaluation) which confirm the diagnosis. This documentation may be no more than five (5)
years old. A copy of the professional report on the standardized psychoeducational assessments given to
identify a learning or learning-related disability must be provided for those so diagnosed. Test scores and their
interpretation must be discussed in the report. The Application for Special Testing Accommodations will not be
reviewed in the absence of the submission of this documentation and will be considered incomplete. Both the
accommodations application and any accompanying documentation submitted to NBCOT are considered
confidential and are reviewed by persons with training appropriate (e.g.,, psychology, professional counseling)
to review assessment reports and psychological reports.
• You should provide a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) diagnosis or a diagnosis
from other appropriate and professionally recognized, psychological or standardized educational
assessment/evaluation (e.g.,, Woodcock-Johnson, Wechsler Adult Intelligence Scale, Nelson-Denny Reading
Test).
• If in the case of a psychological disorder (other than a specific learning disability) where no formal testing has
been done, please be sure to include a psychological report which confirms the diagnosis of the disability. Due
to the sensitive nature of information which may be provided in a psychological report, you may prepare a
report for these purposes which provides sufficient detail to confirm the (1) means by which the diagnosis of a
disability/disorder was made, (2) describes the candidate's current functioning and (3) confirms the need for
testing accommodation. The report should include the following information: (1) date of
evaluation/observation, (2) date of report, (3) reasons for referral, (3) brief overview of general observations and
identification of those behaviors which meet the DSM criteria for diagnosis, (4) history of the course of the
disability, current functioning and the impact of the disability on the ability to test under standard testing
conditions, (4) any test results, (5) multiaxial format for DSM codes or listed diagnoses and (6) testing
recommendations. The report should provide sufficient information to confirm the existence of the disability and
establish the need for recommended testing accommodation(s).
• All documentation should be typed and presented on the professional's stationery/letterhead. Handwritten
reports will not be accepted.
• Please answer every item on the special testing accommodations application.
With respect to candidate's with physical or health-related disabilities. (e.g., , blind, deaf, diabetes):
• You need not provide copies of medical records. However, please provide sufficient documentation from a
physician or appropriate healthcare provider that confirms the diagnosis of a physical or health-related
“disability which substantially limits a major life activity."
• Pregnancy is NOT a disability.
If you have further questions about the completion of the Application for Special Testing Accommodations for
Candidates with Disabilities, please contact the NBCOT at 301-990-7979, extension 3122.

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 NATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY, INC. (NBCOT)
APPLICATION FOR SPECIAL TESTING ACCOMMODATIONS FOR CANDIDATES WITH DISABILITIES

To request accommodations on the certification examination and/or the practice examination, the candidate is to
complete the front of the form. A licensed/certified or otherwise qualified professional whose credentials are
appropriate to diagnose, evaluate and treat the disability is to complete the back of this form. The professional must
have diagnosed, evaluated or treated the candidate within the last five years (5) and have current knowledge of
the candidate’s disability and its impact on major life activities. Candidates with learning disorders or other
mental/psychological disorders must enclose with this form a copy of documentation (i.e., educational assessment
report, psychological report) which provides diagnostic/clinical data confirming the diagnosis. Persons with learning
disabilities must submit subtest and total scores from the psychoeducational assessments given to diagnose.
Documentation should be no more than five (5) years old. Under standard conditions, the certification examination
is a four (4) hour, 200 item, multiple choice examination, without breaks. Answers are recorded on a computer
scannable form. The practice examination is a two (2) hour, computer-delivered 100 item, multiple choice
examination whose answers are recorded by mouse and/or keyboard. The candidate and the professional should
consult and come to agreement as to the reasonable and appropriate accommodations recommended on this form.

TO BE COMPLETED BY THE CANDIDATE (Please PRINT or TYPE all responses):

I. CANDIDATE INFORMATION:

Full Name
Street Address
City, State, Zip Code, Country
Daytime Phone w/ area code ( )
Social Security Number ___ ___ ___ - ___ ___ - ___ ___ ___ ___
School Code ___ ___ ___ ___ ___
Examination Date
OTR or COTA Exam
Exam Repeater (yes/no)
Accommodated on a previous
NBCOT examination? (yes/no)

II. CANDIDATE’S DISABILITY (CHECK ALL THAT APPLY)

Disability √ Disability √
Deaf or hearing impaired Psychological/psychiatric/mental disorder
Blind or visually impaired Orthopedic/physical disability
Specific Learning Disability Other health impairment

III. DISABILITY AND TESTING ACCOMMODATIONS HISTORY:

1. The disability was diagnosed: ____ less than 1 year ago ____ 1-2 years ago ____ more than 2 years ago
2. In high school, I had an Individualized Educational Program (IEP)? ___ YES ___ NO
3. I received testing accommodations for college/graduate school admissions tests? ___ YES ___ NO __ N.A.
4. In college/graduate school I used special services for students with disabilities? ___ YES ___ NO
(If yes, submit the NBCOT Accommodations History Form.)
I certify that the information provided by me on this form is true and correct to the best of my knowledge.
___________________________________________________________________ ____________________________
Candidate’s Signature Date

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CANDIDATE NAME : _______________________________________________________________________________
TO BE COMPLETED BY THE PROFESSIONAL (Please PRINT or TYPE all responses):
I. PROFESSIONAL’S INFORMATION:

Name
Title and Occupation Occupation:
Institution
Address
City, State, Zip Code, Country
Daytime telephone and fax Phone: ( ) Fax: ( )
numbers w/ area code
I am licensed/certified? ___ NO ____ YES as a Licensed/Certified (Profession) :

* * *PLEASE ATTACH YOUR BUSINESS CARD TO THIS FORM.* * *

II. DIAGNOSIS AND TREATMENT INFORMATION:

1. DIAGNOSIS : ____________________________________________________________________________________
(If a specific learning disability or mental/psychiatric disorder provide the DSM-IV diagnosis and code. A COPY OF THE
PSCYHOLOGICAL/PSYCHIATRIC OR EDUCATIONAL ASSESSMENT REPORT (WITH TEST SCORES MUST BE ENCLOSED.)
2.Describe the manner in which this disability impairs major life activity : ___________________________________
___________________________________________________________________________________________________
3. Last date of your treatment or consultation with the candidate:____________________________________________
4. I have consulted with the candidate as to the accommodation needed. Based on my knowledge of this
candidate’s disability and current functioning, and in consultation with the candidate, the following
accommodations are recommended: (Check all that apply.)

III. RECOMMENDED ACCOMMODATION(S) for certification examination and/or practice examination √

Architecturally accessible test site: specify _____ wheelchair access ________ elevator access
Large type for test booklet (certification exam only) : (specify point size: )
Recording answers in the test booklet (certification examination only - no scannable answer sheet )
Reader (with separate room and proctor)
Writer (to record answers on scannable answer sheet and/or by keyboard)
Sign language interpreter: ______ for opening instructions, only; ______ throughout testing period
Separate room and proctor (not due to use of reader, writer or sign interpreter)
Extended Time : ___ 25% extra ___ 50% extra ___ 75% extra ___ 100% extra (double)
Other accommodation(s): specify

I certify that the information provided by me on this form is true and correct to the best of my knowledge.
______________________________________________________________ ____________________________
Professional’s Signature Date

This form (with supporting documentation) MUST be mailed by the application postmark deadline to NBCOT, Attn. Special
Accommodations, 800 S. Frederick Avenue, Suite 200, Gaithersburg, MD 20877.

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 NATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY, INC. (NBCOT)
CONFIRMATION OF ACCOMMODATION HISTORY FOR CANDIDATES WITH DISABILITIES

This form should be completed by professional staff responsible for student disability services at the institution that
the candidate attended during occupational therapy education. This form documents the candidate’s history of
testing accommodation.

(PLEASE PRINT or TYPE)

TO BE COMPLETED BY THE CANDIDATE:

I. CANDIDATE’S INFORMATION:

Full Name
Street Address
City, State, Zip Code, Country
Daytime Phone w/ area code ( )
Social Security Number ___ ___ ___ - ___ ___ - ___ ___ ___ ___
School Code ___ ___ ___ ___ ___
Examination Date
OTR or COTA Exam
Exam Repeater (yes/no)
Accommodated on a previous
NBCOT exam? (yes/no)

THE REMAINDER OF THE FORM IS TO BE COMPLETED BY THE STUDENT DISABILITY PROFESSIONAL

I. STUDENT DISABILITY PROFESSIONAL’S INFORMATION:

Name
Title
Institution
Address
City, State, Zip Code, Country
Daytime telephone and fax Phone: ( ) Fax: ( )
numbers w/ area code

II. CANDIDATE’S DISABILITY STATUS (CHECK ALL THAT APPLY)

Disability √ Disability √
Deaf Psychological/psychiatric/mental disorder
Blind Orthopedic/physical disability
Specific Learning Disability Other health impairment

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III. ACCOMMODATIONS PROVIDED TO CANDIDATE DURING HIGHER EDUCATION
1. The following accommodations were provided for the candidate while a student at this institution (check all that
apply):

ACCOMMODATION(S) PROVIDED √
Large type for test booklet : (specify point size: )
Recording answers in the test booklet (no scannable answer sheet )
Reader (with separate room and proctor)
Writer (to record answers on scannable answer sheet)
Sign language interpreter: ______ for opening instructions, only; ______ throughout testing period
Separate room and proctor (not due to use of reader or sign interpreter)
Extended Testing Time - specify amount of extended time: ______________________________________
Other accommodation(s): specify

2. Provide the dates during which these accommodations were provided:_____________________________________

3. Testing accommodations were arranged for the student and monitored by:

_____ Office of student disability services

_____ Institution’s classroom faculty

IV. DOCUMENTATION OF THE DISABILITY

1. This institution or the disabilities services office has on file (or had on file at the time of accommodations),
documentation/diagnostic data confirming the candidate’s disability: ____ YES ____ NO

I certify that the information provided by me on this form is true and correct to the best of my knowledge.

___________________________________________________________________ ___________________
Signature of Student Disability Services Office Staff Date

This form MUST be mailed by the application postmark deadline to NBCOT, Attn. Special Accommodations, 800 S. Frederick
Avenue, Suite 200, Gaithersburg, MD 20877.

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