* 1. Please enter your contact information

* 2. Are you the primary decision maker regarding a Residency Program at this site? If not, please provide additional information about who is.

* 3. What is the area of practice for which you would like to provide a Residency?

* 4. To which AOTA Certification(s) does this Residency best connect? Information about AOTA Certification programs can be found at www.aota.org/certification.

* 5. At what stage in the planning and development for an OT Residency Program is your organization?

* 6. Do you have a Residency Program at your setting for a discipline other than OT? If so, what disciplines?