OT Forms

Forms

Faxes not accepted. Forms are being updated to reflect such.

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 a related link under "Additional Resources" from the OT Act and Rules page for further information.

Some of the PDF forms below are fillable PDFs and responses may be completed on certain electronic devices, such as a computer. Responses may be typed, handwritten, or completed with a combination of typed and handwritten responses in the designated fields; however, these forms may not be electronically signed or dated. Note that the Board cannot provide any technical assistance regarding the fillable elements of these forms. Refer to the forms for further information, including how to submit them.

 

CE Submission Form (pdf/fillable 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 (pdf/fillable form)

OT/OTA License Renewal Form (pdf/fillable form)

OT/OTA Retired License Application/Renewal (pdf/fillable form)

Re-exam Form (pdf)

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

Restoration of an OT/OTA License Form (pdf/fillable form)

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
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