Facility Name / CCCE Name / Date
Street Address / City / State / Zip / CCCE Email / CCCE Phone
Rotation # and Start Dates / Academic
Program / Clinical Experience
number of weeks,
Differing start dates, & Program Guidelines for Setting or Type / Clin. Exp.
Sequence / # of Slots –
Setting & Type
Pre-Assigned / # of Slots - Setting /Type
OPEN for BID / Comments
Regarding
Slots
1
1-3-17 / APU-DPT / 8 (12/19/16) / 3rd / Mark Open slots only in this box:
CERR-PTA / 6 (1/9) / 1st or 3rd
CHAP-DPT / 8, 12 / 1st , 2nd
LLU-DPT / 11 / 2nd
SDMC-PTA / 8 (1/9) Minimum 190 hours . / 2nd
SDSU-DPT / 8 or 16 (1/16) Prefer 16wks / Final
STBC-PTA / 6 / 2nd
USA-DPT / 8 (1/2) / 2nd
USC-DPT / 16 / Final
WESTU-DPT / 12 (1/2) / 2nd
2
2-13-17 / CCCGG-PTA / 6 / Final / Mark Open slots only in this box:
CCCNH-PTA / 6 (3/13) / 1st
CCCSD-PTA / 6 (3/13) / 1st
CERR-PTA / 6 / 1st or 3rd
CHAP-DPT / 8 (2/27) 12 (1/30) / 1st , 2nd
CSULB-DPT / 12 / Final
3
3-27-17 / CERR-PTA / 6 / 1st or 3rd / Mark Open slots only in this box:
CHAP-DPT / 8 (4/24) 16 (4/24) / Final
LLU-DPT / 10 / Final
LLU-PTA / 6 / 1st
MSMU-DPT / 12 (4/11) / Final
SDMC-PTA / 8 (3/6) (190 hr. minimum) / Final
SDSU-DPT / 8 (3/13) / Final
USA-DPT / 7(3/6), 8 (3/6) / 1st , 3rd
WESTU-DPT / 12 (4/3) / Final
4
5-22-17 / CCCNH-PTA / 6 (5/26) / 2nd / Mark Open slots only in this box:
CCCSD-PTA / 6 (5/25) / 2nd
CSULB-DPT / 6 / 2nd
CSUN-DPT / 6 , 12, 12 / 1st, 2nd, 3rd
USA-DPT / 8 (5/1) / 2nd
USC-DPT / 6 Non OP Ortho / 2nd
WESTU-DPT / 12 (5/22) / 1st
5
7-3-17 / APU-DPT / 10 (6/26) / 4th / Mark Open slots only in this box:
CCCNH-PTA / 6 (7/17) / 3rd
CCCSD-PTA / 6 (7/17) / Final
CHAP-DPT / 8 (6/19) / Final
CSULB-DPT / 6 / 1st
CSUN-DPT / 6 (7/4) / 1st
LLU-PTA / 6 (7/10) / 2nd
MSMU-DPT / 6(7/5)ip or neuro, 12 (7/5)any / 2nd, 4th
SDSU-DPT / 6 / 1st
USA-DPT / 7, 8 / 1st, 3rd
USC-DPT / 6 (7/4) OP/IP Ortho, gen medicine / 1st
6
8-14-17 / APU-DPT / 12 (8/14) / 1st / Mark Open slots only in this box:
CCCGG-PTA / 6 (8/11) / 1st
CERR-PTA / 6 / 2nd
CHAP-DPT / 8, 12,16 / 1st,2nd ,Final
CLC-PTA / 7 (7/24) / 2nd
LLU-DPT / 10 (8/7) / 1st
LLU-PTA / 6 (8/21) / Final
SDSU-DPT / 8 or16 (8/21) Prefer 8wks / 2nd
STBC-PTA / 6 / 1ST
USA-DPT / 8 (8/21) / 2nd
USC-DPT / 16 (8/21) / 3rd
7
9-25-17 / CHAP-DPT / 8 (10/9) , 12 wks / 1st,2nd , Final / Mark Open slots only in this box:
CCCGG-PTA / 6 (10/26) / 2nd
CERR-PTA / 6 / 2nd
CLC-PTA / 7 (9/11) / Final
STBC-PTA / 6 (9/11) / 2nd
8
11-6-17 / APU-DPT / 12(11/13) / 2nd / Mark Open slots only in this box:
CCCGG-PTA / 6 (12/18) / Final
CERR- PTA / 6 / 2nd
CHAP-DPT / 8 (10/23) / 1st,2nd
CSULB-DPT / 12 / Final
MSMU-DPT / 6 (10/31) any Ortho or OP / 1st
SDMC-PTA / 8(10/17) Part time.T/TH class 1pm. / 1st
SDSU-DPT / 8 (10/16) / 3rd
USA-DPT / 7 (10/30) 8 (10/23) / 1st. 3rd
* Each rotation period is 6 weeks. Actual Clinical Experience length will vary with program. Please note differing start dates in parenthesis
**Please be sure to write the facility name, address, Center Coordinator of Clinical Education’s name, telephone, and email address at the top, of the first page of this form.
PLEASE RETURN FORM BY APRIL 1, 2016
YES, our facility wishes to affiliate with the following additional IACCC schools:
Additional Comments:
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