Please note that your answer on the supplemental questionnaire must correspond to the information that is provided on your resume to receive credit.
1
Do you possess a current license as a Physical Therapist from the Maryland State Board of Physical Therapy Examiners in accordance with Physical Therapy Article, Section 13-301 or as an Occupational Therapist from the Maryland State Board of Occupational Therapy Practice in accordance with Occupational Therapy Article, Section 10-301?
Yes
No
2
If you answered Yes to the above question, please provide your license number and expiration date in the space below. If you do not possess a certificate of eligibility, please indicate N/A in the text box below.
3
Do you possess a Master's degree or higher from an accredited college or university in Physical or Occupational Therapy?
Yes
No
4
Please describe your supervisory experience. Include employer name(s), job title(s), dates of employment, and titles of those you supervised. If you do not possess this experience, enter N/A.