Johns Hopkins Hospital

Department of Physical Medicine and Rehabilitation

600 N. Wolfe St., Meyer 1-130

Baltimore, MD 21287

410-614-3234

The Johns Hopkins Acquired Brain Injury Fellowship

Program Application

Application Requirements

Open to new graduates and practicing clinicians

Completion of a Bachelor of Science, Master’s, or Doctoral Degree from an accredited Occupational Therapy academic program

Licensure from State of Maryland, Board of Occupational Therapy Practice; or qualified to obtain licensure

AOTA member

Application Procedures

To support this application, the following must be submitted to the Fellowship Director via email, prior to the application deadline.

☐ Official transcripts from each college or university attended

☐ Career Statement

☐ Resume or Curriculum Vitae

☐ Three Letters of Recommendation

☐ $50.00 application fee (payable through website)

Please send application and associated documents electronically in PDF format to:

Brittaney Colebank, MOT, OTR/L, BCPR, CBIST

OT ABI Fellowship Director

bcoleba1@jhmi.edu

Fellow Applicant Information:

Name: First Name Last Name

Mailing Address: Enter Text

Permanent Address: Enter Text

Phone Number: (###) ###-####

Email Address: Enter Text

Gender Identity: Enter Text ☐ Prefer not to disclose

Educational and Professional Background:

What is your highest academic degree? : Enter Text Here

If you completed a Master’s degree or higher, was an independent research project required?

☐ Yes : Please Indicate Name of Project

☐ No

b) Please indicate Colleges/Universities Attended:

Name of Institution	Year(s) Attended	Area of Study	Degree/Certificate Achieved	Graduation Date
Text	Text	Text	Text	Text
Text	Text	Text	Text	Text
Text	Text	Text	Text	Text
Text	Text	Text	Text	Text

c) Are you currently a member of AOTA?

☐ Yes, AOTA member ID number: Enter Text Here

☐ No

d) Are you currently licensed to practice Occupational Therapy in the state of

Maryland?

☐ Yes

☐ No

☐ No, but eligible for licensure to practice in the state of Maryland

e) Please indicate employment history relevant to field of Occupational Therapy:

Employer	Setting/population served	# hours/week
Text	Text	Text
Text	Text	Text
Text	Text	Text
Text	Text	Text

3. Career Statement: Your statement should be typed and double-spaced. Please consider the following in the preparation of your statement:

What role do you believe Occupational Therapy plays in the practice area of Acquired Brain Injury?

Why have you chosen to apply to the ABI fellowship at Johns Hopkins?

What are your professional goals?

What contributions do you hope to make to your profession?

What challenges do you anticipate with participation in the fellowship program?

4. Include a copy of your professional resume/CV.

5. Letters of recommendation: Please give the enclosed letter of recommendation form to three individuals who would be willing to comment on your abilities. Both new graduates and experienced therapists are eligible to apply. We strongly suggest that you include individuals who are able to comment on your academic and clinical abilities, such as a former supervisor/instructor from an accredited occupational therapy program and/or a physician or therapist that has worked with you in the past.

Name of Evaluator	Address/City/State	Telephone Number
Name 1	Text.	(###) ###-#### Ext. ###
Name 2	Text.	(###) ###-#### Ext. ###
Name 3	Text.	(###) ###-#### Ext. ###

Johns Hopkins Hospital

Department of Physical Medicine and Rehabilitation

600 N. Wolfe St., Meyer 1-130

Baltimore, MD 21287

410-614-3234

Request for Letter of Recommendation

Applicant Name: Applicant Name

To the Applicant: I understand that under provisions of the Family Education Rights and Privacy Act of 1974, I have access to my letters of recommendation. I expressly ☐ Do ☐ Do not

wish to waive my access to this letter. I understand that a waiver of access to my file is NOT required as condition for admission, receipt of financial aid or any other services or benefits.

/

Applicant’s Signature	(type your name)	Date

To the Evaluator: Please include this form with your letter of recommendation, which you can add on the second page; please also include your professional letterhead. Please email the completed document to Brittaney Colebank, MOT, OTR/L, BCPR, CBIST, Occupational Therapy Acquired Brain Injury Fellowship Director at bcoleba1@jhmi.edu. In your recommendation, please share any insights you may have regarding the candidate’s academic abilities, communication skills, personal and professional development, and potential for contribution to the field of occupational therapy in the area of acquired brain injury. Unless the applicant waives their access to your recommendation letter, it will be shared with the applicant upon request, per the Family Education Rights and Privacy Act. Thank you.

Please indicate your relationship with the applicant:

☐Professor

☐Research Advisor

☐Clinical Supervisor

☐Friend/Colleague

☐Other (please describe): Text.

Evaluator Name and Title: Text.

/

Evaluator’s Signature	(type your name)	Date

Facility/University: Text.

Telephone Number: (###) ###-#### Ext. ###/Email Address: Text.