VERIFICATION OF OBSERVATION/JOB-RELATED EXPERIENCE 2025

1. Click ‘Get Form’ to open the VERIFICATION OF OBSERVATION/JOB-RELATED EXPERIENCE in the editor.
2. Begin by entering the applicant’s name in the designated field, ensuring accuracy for proper identification.
3. Fill in the supervisor’s name and the name of the facility where the observation took place.
4. Complete the address fields including city, state, and zip code of the facility to ensure it is correctly documented.
5. Provide the facility phone number for any necessary follow-up communications.
6. Indicate your role as a supervisor by checking the appropriate box under 'Physical Therapy Setting' and 'Patient Types'.
7. Document whether the applicant was a volunteer or employee, along with total hours observed and date of observation.
8. Optionally, add comments regarding work readiness skills or qualifications observed that may aid in selection for the PTA program.
9. Finally, sign and date the form to certify that all information provided is accurate before submitting it as instructed.

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