OT Forms

Forms

Make out checks to ECPTOTE and mail to: ECPTOTE, 333 Guadalupe St. #2-510, Austin, TX  78701-3942.

Change Contact Info 

Change of Supervision (online submission form)

Consumer Sign (pdf)

Employment History Form (pdf)

Mentorship Agreement (pdf): This is an optional form that may be used by those completing a mentorship experience for CE.

Military, Military Spouses, Veterans Initial Licensure Fee Waiver (pdf)

OT/OTA Application for Initial Texas Licensure

OT/OTA License Renewal Form (pdf)

OTA Supervision Form (pdf): This form is for OTAs holding a regular license, NOT  for temporary licensees or those applying for a temporary license.       

OTA Supervision Log (pdf): To be used by occupational therapy assistants with a regular or temporary license 

Re-exam Form (pdf)

Replace a License (includes with Name Change) (pdf)

Restoration of an OT/OTA License Form

Retired License Application/Renewal (pdf)

SSN Statement (pdf)

Temporary Occupational Therapist Licensee Supervision Record (pdf): To be used by occupational therapists with a temporary license

Temporary Supervision Form (pdf): This form is to be used by temporary licensees or those applying for a temporary license. This form may not be faxed or sent by email.

 

 
get adobe_reader

333 Guadalupe, Suite 2-510 • Austin, TX 78701-3942 • Phone: (512) 305-6900
Fax: (512) 305-6970 or (512) 305-6951 • www.ptot.texas.gov • Contact Us  •  Sitemap

Texas.govTexas Homeland Security TRAIL Texas Veterans Portal | TX Occupations Code | Where the Money Goes
Search TX State Sites SAO Fraud Reporting | Poison Control Center Governor's Committee on People with Disabilities