Guide to LATI Forms

Foreword: The following descriptions give a synopsis of the various forms that LATI utilizes to address fieldwork issues. Copies of these forms are to be made when the need arises. If replacements are ever required please contact the Academic Fieldwork Coordinator

Supervisor Evaluation of Supervisor

This form must be completed by the Fieldwork Educator/Supervisor/Clinical Supervisor or Facility Fieldwork Coordinator and sent to LATI each time a student has completed a Level I Fieldwork Experience at the facility. The student has been provided with this form and should present it to the facility personnel upon arrival to the Fieldwork setting. However, this form may be reproduced if necessary.

Student Evaluation of the Fieldwork Experience

Each student who is assigned to your facility will be required to complete this form and review it with the Fieldwork Educator or Facility Fieldwork Coordinator. This will need to be signed by a facility representative and returned to LATI by the student. Each student will be issued this form and take it with them to the site.

Supervisor Grievance Form

This form is to be filled out by the Fieldwork Educator or Facility Fieldwork Coordinator in the event of a grievance against a LATI OTA student. This form may be reproduced if needed. Please send completed form to The LATI OTA Fieldwork Coordinator.

LATI Accommodations Request Form

This form is utilized for students that request special accommodations for a documented disability.

LATI Placement Request Form

This form is sent out to fieldwork site to address possible placements for a specific calendar year. It lists various OT areas in which a facility may be able to accommodate a student placement.

LATI Student Information/Profile Packet

This packet is sent out to the site prior to the student attending a fieldwork experience. It gives the fieldwork site pertinent student information. It includes forms that address or provide proof of immunization, insurance, confidentiality, CPR and ECT