Fieldwork Data Form - University Of Southern Maine Page 4

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(Check
those who supervise OT fieldwork students)
Degree and
Years
Name and (OT/OTA)
Title
OT Specialty
College/University
in OT
COMMENTS: (e.g., the general environment of your clinical site)
AOTA Commission on Education (COE) and Fieldwork Issues Committee (FWIC)
Amended and Approved by FWIC 11/99 and COE 12/99
(fieldwork\miscell\dataform.1299)
3

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