OT Forms

Forms

Make out checks to ECPTOTE and mail to: ECPTOTE, 333 Guadalupe St. #2-510, Austin, TX  78701-3942.

Note: Changes that went into effect June 1, 2019 removed certain requirements for OTAs with a regular license, including removing the requirement that OTAs with a regular license maintain a supervision log and that they submit the OTA supervision form and information regarding changes in supervisor. Refer to the "Proposed/Adopted" tab from the OT Act and Rules page for further information.

 

CE Submission Form

Change Contact Info 

Consumer Sign (pdf)

Employment History Form (pdf)

Mentorship Agreement (pdf): This is an optional form that may be used by those completing a mentorship experience for CE.

Military, Military Spouses, Veterans Initial Licensure Fee Waiver (pdf)

OT/OTA Application for Initial Texas Licensure

OT/OTA License Renewal Form (pdf)

Re-exam Form (pdf)

Replace a License (includes with Name Change) (pdf)

Restoration of an OT/OTA License Form

Retired License Application/Renewal (pdf)

SSN Statement (pdf)

Temporary OTA Licensee Supervision Log (pdf) This form is to be used by temporary OTA licensees only.

Temporary Occupational Therapist Licensee Supervision Record (pdf): To be used by occupational therapists with a temporary license

Temporary Supervision Form (pdf): This form is to be used by temporary licensees or those applying for a temporary license. This form may not be faxed or sent by email.

 

 
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ECPTOTE, 333 Guadalupe, Suite 2-510 • Austin, TX 78701-3942 • Phone: (512) 305-6900
Fax: (512) 305-6970 or (512) 305-6951 • www.ptot.texas.gov • Contact Us  •  Sitemap

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