Maryland OccupationalTherapy Association 2017Henrietta Price Scholarship Application

Each year, MOTA accepts applications from its student members for a merit-based scholarship. The scholarship award is given to those MOTA students who are in good academic standing;have demonstrated through hands on experience (fieldwork, volunteering or paid employment) knowledge of occupational therapy services; and can articulate and discuss his/her commitment to professional development and growth.

Candidates must either be (1) enrolled full-time in a Maryland college or university occupational therapy degree program or (2) a Maryland resident who has the intent to work in Maryland but is enrolled in an out-of-state, accredited occupational therapy degree program. All applicants must have had at least one term or semester of OT or OTA course work completed before applying.

Scholarships areawardedbaseduponthe following:

Academicperformance

Hands onexperiencerelatedtoOTservicedelivery

Commitmenttoprofessionaldevelopment and leadership

The Application DEADLINE is October 13, 2017. Scholarshipwinnerswillbenotifiedthe week of October 30, 2017.

Instructions:Follow these guidelines. Incompleteapplicationswillnotbeconsidered.

  1. Verify that you are an active MOTA member by obtaining your membership ID number. Log onto the website, mota.memberlodge.org, and click “View Profile.”
  2. Arrangetohavearecent,official transcriptsentby yourcollege/universityRegistrarto theaddressbelow.Thetranscriptmust show you have completed at least one term of course work and report your GPA as of the mostrecentterm. Applicants presenting aGPAof 3.0orhigher willreceive primary consideration.
  3. Candidates who are enrolled in an out-of-state OTAor OTACOTEaccredited programmust include a valid and current official document substantiating full-time Maryland residency, such as the Maryland Income Tax Form. A signed statement of intent to reside in Maryland post-graduation must accompany the document.
  4. Secure twoprofessionalreferencesto be emailed, faxed or mailed to the address below. Bothreferencesshouldaddress the applicant’sacademic achievement andskillsrelated to the potential as an occupational therapy practitionerand/orprofessional leadership.
  5. The documents must bear an original signature or e-signature.
  6. Reference#1 mustbefromafacultymemberof theOTA/OTprogramyou are attending.
  7. Reference #2 should bean occupationaltherapy practitionerora person who is knowledgeable about occupational therapy and holds apositionof authorityin an organization,inwhichyouvolunteered,had paidemployment,or completeda fieldworkrotation.
  8. Referencesfromfamilyand/or immediatehousehold ordomesticpartners will not be accepted.
  9. Complete the application in its entirety. Ensure that the three pageapplication and all supporting documents are sent or faxed to the address below. Unsigned or illegible applications will not be considered. Keep a copy for your records. No submissions will be returned.

By Mail: By Fax: By Email:

Derek Piggott(410)

8000 York Rd

Towson MD 21252

Section1:PersonalInformation

Name: ______MOTA ID#: ______

Mailing Address:______Email Address:______

______

Daytime Phone: ______Evening Phone: ______

Please provide the names of the individuals who will be submittingyour references:

______

______

Section2:EducationalBackground

Degree being pursued: ______

College/universitywhereyouareafull-timeOT/OTAstudent: ______

College/university student ID #: ______DateEnrolled: ______

Cumulative GPA: ______Anticipated Graduation (mm/yyyy): ______

Semester cost of tuition, books, and fees to you:______

List othercolleges/universities attended (dates,majors, awarded degrees):

Section3:Narrative

On the following page, compose a typed essay that addresses thepoints below. Please format the page using 1” margins; 1.0 line spacing;and size 11 or 12 font.

  • Whathave beenyourhealth-relatedexperiencestodate(mention dates,facilities/agencies,your position/description, ifvolunteerorpaid)?
  • Tell us about the personal significance of these experiences.How have they impacted you?

In what ways have they helped you?

  • What doyouhope to achieve as anoccupationaltherapist/occupational therapy assistant?
  • Explain how professionalism is important to you. Elaborate on your activities that have helped develop your professionalism (that is, attended conferences or educational eventsoutsideofyouracademicprogram,participated in AOTA sponsoredeventssuchasCapitolHillDay, volunteered at the MOTA conference, etc.).
  • Why do you deserve thescholarshipmonies?

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Maryland OccupationalTherapy Association 2016Henrietta Price Scholarship Application

Section4:Bursar Information

If chosen, the name and address of the college representative to whom the check should be sent is

______

______

______

______

My account number to reference is ______.

Section5:Student Scholarship ApplicationAgreement

Inapplyingfora MOTA Scholarship,youareacknowledgingthefollowingstatements are true:

Decisions regardingtherecipientsof theaward(s)aremadebytheMOTA ScholarshipCommitteeandall decisions arefinal.

Nosetmonetary amountornumber ofrecipientsisguaranteed.

Theinformationsubmittedinthis applicationiscomplete and correcttothebest ofknowledge.

Iunderstandthis isonlyanapplicationanddoesnotguaranteeaMOTA student scholarship.

Knowinglyprovidingfalse informationwilldisqualifymefromtheMOTA StudentScholarship.

Toreceivethescholarship monies, Imust be a current MOTA member and enrolledandin goodstanding in an accreditedACOTEOT/OTA program.

Iam worthyofreceivingscholarship moniesbasedonmerit.

Iwill usethescholarshipmonies forpursuing myeducationalOT/OTAgoal.

Signatureof Applicant: ______Date:______

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