University of Washington Neurologic Physical Therapy Residency Program

University of Washington

Neurologic Physical Therapy Residency Program Application

Please print out application form and return in one complete packet to:

University of WashingtonMedicalCenter - Physical Therapy

Attention: Victoria Stevens, PT, NCS

Box Number 356154

1959 NE Pacific Street

Seattle, WA98195-6154

Deadlines: Completed application forms, all supporting materials (official transcript, letters of recommendation), and the application fee must be received no later than February 1, 2013. Top applicants will be granted anin-person interviewon April 15, 2013 and notification of acceptance will occur by mid-May. The 12-month program begins on August 1, 2013.

For any questions regarding the application process, please contact Vicki Stevens at or Stacia Lee at .

Applicant Components:

  1. Contact information sheet (see below)
  2. Personal Statement addressing the following:
  3. Why you are pursuing a clinical residency experience
  4. Your personal and professional goals for participating in the residency program
  5. Specific qualifications that makes you a good candidate for the University of Washington Neurologic Physical Therapy Residency Program

Please limit to 2 pages, double spaced.

  1. Current Curriculum Vitae that includes at least the following (if applicable):
  2. Education (institute, degree, years of attendance)
  3. Professional experience. If you have less than 1 year experience as a licensed Physical Therapist, please include your Physical Therapy affiliations that were at least 10 weeks long.
  4. Teaching experience
  5. Continuing education courses, including course name, instructor, and approximate number of contact hours
  6. Other neurology specific experience and/or course work
  7. Other recognition
  8. One official copy of transcript from completed Physical Therapy Graduate Program.
  9. Two letters of recommendation and Applicant Rating Forms (see below)from individuals who know your academic and/or clinical potential as a Physical Therapist.
  10. For individuals within 2 years of graduation from a physical therapy program:
  11. One letter of reference and rating form should come from an academic professor or advisor.
  12. One letter of reference and rating form should come from a clinical instructor or recent employer.
  13. For individuals who have greater than 2 years of experience as a physical therapist, both letters should come from professional references (colleagues and/or supervisors) who have the ability to best speak to your professional practice.

Have the individual place the letter of recommendation and Applicant Rating Form in a sealed envelope with his/her signature across the seal, and mail the sealed envelope with your application. The letter should address:

-How does the applicant compare to other physical therapy students or employees you have had?

-How does this applicant handle stress?

-Did the applicant demonstrate evidence-based practice?

-How did the applicant’s clinical reasoning develop and progress over time?

-What would you like us to know about this applicant?

  1. Current Physical Therapy License for Washington State:
  2. Participants must show evidence of full licensure by August 1, 2012, the start of the program. Full licensure means passing the licensing exam and currently in possession of a valid Washington state physical therapy license. The University of Washington Medical Center Neurologic Physical Therapy Residency Program reserves the right to rescind an applicant’s offer if no proof of full licensure is made available.
  3. Out-of-state applicants are encouraged to initiate their Washington Physical Therapy licensure at the same time an application is made to the program. The licensure process normally takes 4-5 months to complete for U.S. trained Physical Therapists. To obtain the Washington Physical Therapy licensure application, contact:

Washington State Department of Health

Board of Physical Therapy

PO Box 47877

Olympia, WA98504-7877

(360) 236-4700

  1. Application fee of $30.00 payable to University of Washington Medical Center Physical Therapy Department.

2013-2014 Application Form

University of Washington Neurologic Physical Therapy Residency Program

University of Washington

Neurologic Physical Therapy Residency Program

Contact Information

Last Name / First Name / Middle Name
Mailing Address
City / State / Zip Code
Preferred Phone Number / Email Address

2013-2014 Application Form

University of Washington Neurologic Physical Therapy Residency Program

University of WashingtonNeurologic Physical Therapy Residency Program

Letter of Reference and Applicant Rating Form

Instructions to Applicant: Please print this form for each individual from whom you request a letter of reference. Complete the Applicant Statement before giving this form to the individual from whom you request a letter. One letter of reference and applicant rating form should come from an academic professor or advisor, and one letter of reference and applicant rating form should come from a clinical instructor or recent employer. The completed letter of recommendation and Applicant Rating Form should be placed in a sealed envelope, and the individual providing this reference should place their signature across the seal. Mail the sealed envelope with your application.

Applicant’s Statement:

I understand that under the provisions of the Federal Family Education Rights and Privacy Act of 1975, I have access to my “letters of recommendation.”
I / DO or DO NOT (circle one) / wish to waive my access to this letter of recommendation.
I understand that a waiver of access to my file is not required as a condition for admission or any other services or benefits.
Applicant Name (print)
Applicant Signature / Date

Instructions to Rater: You are being asked to provide a letter of reference and applicant rating for the above individual for application to the University of Washington Neurologic Physical Therapy Residency Program. Please complete the Applicant Rating Form (below) and a brief letter of reference that elaborates on the applicant’s strengths and weaknesses as a potential participant in a Neurologic Physical Therapy Residency Program. Your letter should address the following questions:

  1. How does the applicant compare to other physical therapy students or employees you have had?
  2. How does this applicant handle stress?
  3. Did the applicant demonstrate evidence-based practice?
  4. How did the applicant’s clinical reasoning develop and progress over time?
  5. What would you like us to know about this applicant?

Please place completed Applicant Rating Form and letter of reference in a sealed envelope with your signature across the seal and return to applicant.

University of WashingtonNeurologic Physical Therapy Residency Program

Letter of Reference and Applicant Rating Form

Rater Information:

Name / Title
Relationship to Applicant
Preferred Phone Number / Email
Signature / Date

Please complete the following Applicant Rating Form. A description of items is provided on the following page.

Applicant’s Ability or Characteristic
(see next page for examples) / Not Observed / Below Entry- Level / Entry-Level / Above Entry-Level / Board Certified Specialist Level
Knowledge Areas / Foundation Sciences
Behavioral Sciences
Clinical Sciences
Sciences Related to Critical Inquiry
Professional Roles, Responsibilities, and Values / Leadership
Virtuous Behavior
Education
Consultation
Evidence-Based Practice
Patient/Client Management / Examination
Evaluation
Diagnosis
Prognosis
Intervention
Outcomes

Overall Recommendation:

Strongly Recommend / Recommend / Recommend with Reservation / Do Not Recommend

University of WashingtonNeurologic Physical Therapy Residency Program

Letter of Reference and Applicant Rating Form

Definitions of Applicant’s Ability or Characteristic (based on the Physical Therapy Neurologic Description of Specialty Practice):

  1. Knowledge Areas of Neurologic Clinical Specialists
  2. Foundation Sciences: including changes across the lifespan, Anatomy/Neuroanatomy, Physiology/Neurophysiology, Movement Science, Physics
  3. Behavior Sciences: Psychology/Neuropsychology, Teaching and Learning Theory, Communication, Decision Making
  4. Clinical Sciences: Kinesiology, Pathokinesiology, Pathology, Pharmacology, Motor Development, Psychiatry, Epidemiology
  5. Sciences Related to Critical Inquiry: Research Design, Statistics
  1. Practice Expectations
  1. Professional Roles, Responsibilities, and Values
  2. Leadership: models professionalism and maturity in decision making and interpersonal interactions, identifies multiple strategies to resolve a problem, collaborates with others to solve problems
  3. Virtuous Behaviors: Commitment, caring, and compassion. Models respect and compassion for all people, establishes trustworthy relationships with colleagues, patients/clients, employers, and the public.
  4. Education: implements, evaluates, and modifies an educational plan/learning experience, educates Physical Therapy students, Physical Therapists, health care professionals to enhance knowledge in Physical Therapy.
  5. Consultation: effectively contributes to patient management in multidisciplinary setting, develops and implements new programs to promote health and fitness
  6. Evidence-Based Practice: evaluates and appropriately applies new research information to clinical practice, participates in planning and conducting clinical research
  7. Patient/Client Management
  1. Examination: History, Systems Review, Tests and Measures
  2. Evaluation: develops clinical judgment based on data collected from the examination
  3. Diagnosis: interprets data from the examination to develop a differential diagnosis
  4. Prognosis: predicts optimal level of improvement in function, develops a plan of care that prioritizes interventions
  5. Intervention: selects and modifies interventions based on an on-going evaluation and prognosis and changes across the lifespan, type and severity of involvement, and potential benefit relative to physiological or fiscal cost to the patient
  6. Outcomes: selects appropriate outcome measures, analyze and interpret data to modify own future practice

For questions regarding this form, please contact Vicki Stevens at or Stacia Lee at

2013-2014 Application Form