Interest in Contributing to ILOTA Educational/Promotional Videos

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Name (First and last) *

Email *

Phone number *

What is your role? *

Occupational Therapist

Occupational Therapy Assistant

OT Student

OTA Student

Other:

If you are a practitioner, what type of setting(s) do you work in?

What region of Illinois do you live/work in?

Northeast

Northwest

Central

Southern

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What type of content would you be willing to contribute? (Check all that apply) *

I would like to talk in a quick video clip about why I chose OT as a career or what I like most about OT as a profession.

I would like to talk in a longer video clip about what OT looks like in my practice setting.

I would like to share a specific 'client success story' about someone that I work/worked with. I would be able to get client permission to share photos/videos.

I would be able to share photos or videos that show what practice looks like in my setting or me working with clients. I would be able to get signed consent forms (provided by ILOTA) for anyone in the videos/photos.

Required

What would you want to share? Please give us some details. *

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