Amplify OT Membership - Student Edition
Thanks for your interest! I'm excited to have the opportunity for Amplify OT to support you in preparing the future of the occupational therapy profession! Learning Medicare policy and engaging in advocacy doesn’t have to be hard… in fact.. it can be fun. I’m here to make things easier on you and your students. 
The On-Demand Medicare and Reimbursement course is included as part of the Amplify OT Membership - Student Edition along with many other bonus resources your students will enjoy. 

This is simply an intake form. Filling out this form helps me get you the information you need to make a decision on if it is a good fit for your program. You are not committing to anything at this time 🙂. 
Sign in to Google to save your progress. Learn more
Email *
Name *
University/ School *
Position *
What type of program are you interested in enrolling in our program? (Select all that apply) *
Required
How many students are in one cohort? *
Required
How do you plan to enroll students in the Amplify OT Membership - Student Edition *
Required
What is a concern or barrier you have when it comes to teaching about Medicare, reimbursement, or advocacy? (i.e. finding updated materials, comfort with information, experience, etc.) *
What do you hope Amplify OT can help you with?  *
Optional: How did you hear about Amplify OT's Membership and course? *
Required
If the form doesn’t immediately show as submitted, scroll up a smidge and you may see a recaptcha image selection. 

We will be in touch with you soon! Keep an eye out for an email from admin@amplifyot.com or cgrote@amplifyot.com
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy