Campbell university physical therapy 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name in the 'Name of Applicant' field. This identifies you as the individual completing the observation hours.
3. Fill in the 'Name of Facility' and its address, including street, city, state, and zip code. This information is crucial for verifying where your observation hours took place.
4. Provide details about your supervising physical therapist by entering their name, license number, email, and phone number. Ensure accuracy for effective communication.
5. Indicate whether you requested a reference from the PT by selecting 'Yes' or 'No'.
6. Select the type of experience (Inpatient/Outpatient) and specify if it was paid, volunteer, or both.
7. Check all applicable PT settings where you observed: Acute Care, Outpatient Clinic, etc., and provide details on any other settings.
8. Document your observed specialty areas along with the corresponding hours spent in each area. Make sure to total your hours accurately.
9. Finally, enter the start and end dates of your observation period before obtaining the supervising PT's signature and date.

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