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#19-004283-0001
Supplemental Questionnaire

Last Name
First Name

 

Please ensure your responses to the following supplemental questions are documented in the spaces provided for each question.  This includes dates of employment and employer information. Otherwise, you will not receive credit for the questions.


1.

Do you possess a Bachelor's or Master's degree in Therapeutic Recreation or Recreation with a major in Therapeutic Recreation from an accredited college or university?

Yes No
2.

Describe your experience as a professional therapeutic recreator, under the supervision of a licensed Occupational Therapist, licensed Physical Therapist or certified Activity Therapist, which included the responsibility for clients’ assessments and the planning, implementation and evaluation of clients’ recreation therapy treatment in a mental health or developmental disability setting.

Please note that experience in assisting with these responsibilities will not be accepted as qualifying experience.  If no experience, please type N/A.

3.
Do you possess a current certification as a Therapeutic Recreator from the National Council for Therapeutic Recreation Certification? (If yes, please attach a copy of your certification to your application.)
Yes No

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