Nomination Form

The California Occupational Therapy Fieldwork Council (CAOTFC) has recently established the Fieldwork Educator of the Year Award! If you believe you are or know someone who merits nomination, please take a few minutes to complete the form below. Submit your nomination to the CAOTFC website in the FALL, so that your nomination will be considered prior to our committee review the following SPRING. The winner of this award will be recognized at one of the following year’s regional CAOTFC conferences and recognized at all regional conferences.

IN RECOGNITION of outstanding leadership, mentorship and teaching abilities, in providing fieldwork education to occupational therapy and/or occupational therapy assistant students throughout the state of California, I nominate the following practitioner for the Outstanding Fieldwork Educator Award:
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Email *
Your Name, Credentials *
Nominee’s Name/Credentials *
Nominee’s Email *
Nominee's Phone
Name of Facility/Practice Center (Where Nominee works) *
Please briefly describe the practice setting and job responsibilities of the nominee. *
Please provide a narrative supporting statement of why the nominee is deserving of the OUTSTANDING FIELDWORK EDUCATOR AWARD for supervising OT/OTA students. In this statement, please use the following selection criteria as a guide for your response:
• Takes initiative to update knowledge concerning best-practice standards of the profession through self-study, and/or attendance at workshops, seminars, etc.
• Acts as a positive role model for students, demonstrating competency in area of expertise and application of research evidence to occupation-based and client centered-practice.
• Communicates effectively with students at varying levels of experience and adapts his/her leadership style to meet student needs.
• Takes initiative to acquire new knowledge of teaching/mentoring strategies and consistently applies information to fieldwork education of occupational therapy students.
• Consistently takes students throughout the year (desired, but not required)
Narrative Response (you may find it useful to write your response in a Word doc, then copy/paste) *
Thank you for submitting your nomination for the Outstanding Fieldwork Educator Award!
A copy of your responses will be emailed to the address you provided.
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