LOW VISION RENEWAL APPLICATION Completion Guidelines and Attestation Item(s) to Submit The following should be sent to basc@aota.org by the application deadline. A single combined document, preferably PDF, is encouraged. Certification Application (this document) Employment/Volunteer Verification Form Professional development activity forms Any additional evidence as required by a particular activity (e.g., CE certificates) Renewal application fee of $325 (submitted separately from application): Credit card: Call (800) SAY-AOTA (800-729-2682) extension 1708 Monday- Friday between 9:00-5:00 Eastern to pay by phone. If no answer, please leave a message and your call will be returned by the end of the week. You will not be considered late. Please do not leave a CC number in the message. Check: Mail check on or before the application deadline to Attn: Certification - AOTA 4720 Montgomery Lane Bethesda, MD 20814-3449 Applicant Attestation I hereby attest that the information provided in this application is my own and that I have complied with all Principles and Standards of Conduct of the Occupational Therapy Code of Ethics and Ethics Standards, including Beneficence; Non- maleficence; Autonomy, Confidentiality; Justice; Veracity; and Fidelity. If granted certification, I will not use my credential to represent myself to others beyond the level for which I am qualified. Signature (electronic signature acceptable) Date
LOW VISION RENEWAL APPLICATION Completion Guidelines and Attestation Item(s) to Submit The following should be sent to basc@aota.org by the application deadline. A single combined document, preferably PDF, is encouraged. Certification Application (this document) Employment/Volunteer Verification Form Professional development activity forms Any additional evidence as required by a particular activity (e.g., CE certificates) Renewal application fee of $325 (submitted separately from application): Credit card: Call (800) SAY-AOTA (800-729-2682) extension 1708 Monday- Friday between 9:00-5:00 Eastern to pay by phone. If no answer, please leave a message and your call will be returned by the end of the week. You will not be considered late. Please do not leave a CC number in the message. Check: Mail check on or before the application deadline to Attn: Certification - AOTA 4720 Montgomery Lane Bethesda, MD 20814-3449 Applicant Attestation I hereby attest that the information provided in this application is my own and that I have complied with all Principles and Standards of Conduct of the Occupational Therapy Code of Ethics and Ethics Standards, including Beneficence; Non- maleficence; Autonomy, Confidentiality; Justice; Veracity; and Fidelity. If granted certification, I will not use my credential to represent myself to others beyond the level for which I am qualified. Signature (electronic signature acceptable) Date