Physical Therapist Assistant Program - Tarrant County College

APPENDIX EDOCUMENTATION OF WORK EXPERIENCE FORM (WEF) - Page 1 of 2Instructions to the Applicant:See section titled “Admissions Rankings” for purpose and use of this form.The applicant will provide the employer this both sheets of this form and a stamped, addressed envelope. Addressshould be to: TCC Physical Therapist Assistant – Application - Trinity River East Campus, 245 East Belknap, FortWorth, TX, 76102.Do not send this form with the program application. This form must be completed by the employer and bemailed by the employer. The envelope must be postmarked by April 1, 2013.Before mailing, it is recommended that the student make a personal copy of the form.If you worked for more than one company, submit a separate form for each. If you are submitting PT tech orobservation hours, the PT or PTA you were with must sign the form as well.We do not accept forms originating from other PTA programs.If you submitted this form last year AND you have additional hours to submit, please submit new form ONLYfor the new hours. We still have last year’s forms and will simply add your new hours to the old hours. Please markthe appropriate box on the form if you are submitting new hours.Instructions to the Employer: Must submit a new form each yearThe person listed on the following page has applied for admission to the physical therapist assistant program atTarrant County College, Fort Worth, TX. To satisfy admissions criteria, we require documentation of experience inphysical therapy or another healthcare-related field. Your prompt response will assist in completing the applicant’sfile.On the next page, please mark the category (or categories) that best describes the position held by the applicant.Write in the total clock hours completed for each category. An accurate total must be identified as the applicant maybe asked to provide documentation (i.e. pay stubs) to confirm hours worked. Inaccurate information will void thestudent’s application.Please avoid identifying the total hours worked as a minimum (i.e. “2000+”). All hours must have been completed inthe United States. Do not include hours completed prior to April 1, 2008. Note: This form is not a reference.Employer, place completed form in stamped, addressed envelope provided by student. Before mailing,write your signature across the envelope seal. Do not give the form to the student to mail. Envelope mustbe postmarked by April 1.Physical Therapist Assistant Program– 2013 Admissions Information Booklet - Revised Oct 2012Page 25