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The Mary Kasch Hand Therapy Certification Scholarship is a financial scholarship awarded to a well deserving occupational therapist or physical therapist preparing for the hand therapy certification examination. The scholarship is valid for the November 2019 and May 2020 examination. If you do not plan on taking the exam on one of these dates please do not apply.

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1. Please complete the following

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2. Please enter your email address:

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3. Are you a(n)

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4. What year did you become licensed or certified as a(n) OT or a PT?

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5. How many years have you treated 50% or more upper extremity patients?

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6. Identify below your work history as an OT or PT in hand therapy. Include name of employer, dates worked and percentage of Hand/Upper Extremity Caseload per employer.

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7. How many hours of direct practice experience in hand therapy would you estimate that you have acquired from these employers? (Full time employee is 40 hours per week, 100% = 2,000 hrs/yr, 75% = 1,500 hrs/yr, 50% = 1,000 hrs/yr and 25% = 500 hrs/yr).

  2,000 hours or less 2,001 to 3,000 hours 3,001 to 4,000 hours 4,001 to 5,000 hours Greater than 5,000 hours
Direct Practice Experience Hours:

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8. Have you completed a hand therapy fellowship program?

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9. CONTINUING EDUCATION
Identify below your continuing education (courses, online education, study groups, study clubs and journal clubs related to the hand/wrist/elbow/shoulder) within the past five years. Include number of hours that were hand/upper extremity related.

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10. CURRENT MEMBERSHIP ORGANIZATIONS
Please indicate the professional organizations that you are currently a member of, whether you are currently active and if you have participated as a committee or task force member.

  ASHT AOTA or APTA State OT or PT Local Hand Therapy Study Group None
Organization:
Committee or Task Force Member:

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11. VOLUNTEER WORK National – State – Local
Indicate Not-for-Profit Organization(s) or other Relevant Volunteer Work (must be within the medical field) within the past five years.

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12. Why do you believe it is important to become a CHT? (There is space for 20 lines of text)

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13. EXAMINATION ELIGIBILITY REQUIREMENTS
Indicate below which of the eligibility requirements you currently meet to sit for the certification examination.

  OT or PT for a minimum of three years, based on issue date of the certificate Accrued a minimum of 4,000 hours of Direct Practice Experience in hand therapy I do not meet either of the eligibility requirements at this time
Eligibility

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14. Tentatively, when do you plan to take the examination?

T