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Kentucky Board of Licensure for Occupational Therapy

Board of Licensure for Occupational Therapy
Applications and Forms

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Note: The documents on this page are in Adobe Acrobat (PDF) format. Please click on the following link to download a free copy of Adobe Acrobat Reader.

Please be advised that these documents will allow you to type in your information, print, and mail.  They will not allow you to save your document, so remember to keep a copy for your own files.

 

 Forms Library

 
  
  
  
  
2014 Annual Renewal Application.pdf
  
105 KB 8/21/2014 9:15 AM
2014 Audited Annual Renewal Application.pdf
  
107 KB 8/21/2014 9:15 AM
Applicant Review Sheet.pdf
  
72 KB 1/26/2012 11:46 AM
Application for Continuing Education Program Approval for Course Providers.pdf
  
27 KB 5/3/2011 11:41 AM
Application for License Verification.pdf
  
45 KB 3/28/2013 10:29 AM
Application for Licensure as an Occupational Therapist.pdf
  
183 KB 10/2/2012 12:09 PM
Application forLicensure as an Occupational Therapy Assistant.pdf
  
186 KB 10/2/2012 12:09 PM
Deep Physical Agent Modalities (DPAM) Continuing Education Approval Application.pdf
  
26 KB 5/3/2011 11:42 AM
Deep Physical Agent Modalities (DPAM) Specialty Certification Application.pdf
  
257 KB 12/5/2012 1:52 PM
Deep Physical Agent Modalities (DPAM) Supervisor Application.pdf
  
25 KB 5/3/2011 11:42 AM
Form to File a Complaint.pdf
  
12 KB 5/3/2011 11:40 AM
Letter of Supervision for Issuance of a Temporary OT or OTA Permit.pdf
  
84 KB 9/17/2013 9:14 AM
Mailing List Request.pdf
  
103 KB 1/2/2013 1:52 PM
Name-Address Change Form.pdf
  
184 KB 12/6/2012 9:37 AM
Open Records Request.pdf
  
35 KB 6/4/2012 10:05 AM
OT Complaint Form.pdf
  
188 KB 6/28/2013 3:22 PM
Reinstatement Application for an Occupational Therapist.pdf
  
101 KB 4/2/2012 8:45 AM
Reinstatement Application for an Occupational Therapy Assistant.pdf
  
101 KB 4/2/2012 8:45 AM
Supervision Audit Checklist Form.pdf
  
98 KB 2/8/2012 9:14 AM