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Physical Therapist Assistant Complete Program Information

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ILLINOIS CENTRAL COLLEGE <br />

PHYSICAL THERAPIST ASSISTANT PROGRAM <br />

DOCUMENTATION OF OBSERVATION HOURS <br />

Student Name: ____________________________________________ <br />

Student ID # : _____________________________________________ <br />

To ICC <strong>Physical</strong> <strong>Therapist</strong> <strong>Assistant</strong> <strong>Program</strong>: <br />

______________________________________________________ has completed <br />

observation hours in the <strong>Physical</strong> Therapy Department at the facility of: <br />

__________________________________________________________________<br />

from the dates of _____________________ through ______________________ <br />

for a total of _____________________ hours. <br />

Sincerely, <br />

<strong>Physical</strong> Therapy Department <br />

ENCLOSE COMPLETED OBSERVATION FORMS WITH APPLICATION PACKET <br />

PTA <strong>Program</strong> Info 7-2013.doc Page 19 of 20

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