If the CLVT applicant has completed the required clinical practice (350 hours) at more than one agency/clinic, please list the additional agencies/clinics: (Name of agencies/clinics, addresses, phone numbers, dates of practice). DIRECTIONS: For each competency listed below, please indicate whether the applicant passed or did not pass. All competencies require a rating and all competencies must be passed for the applicant to sit for the CLVT examination. Competencies: Did the applicant… Pass Fail Comments 1. Demonstrate appropriate interpersonal relationships and the ability to work closely with colleagues and community professionals as a member of the interdisciplinary low vision team including OD/MD ? 2. Demonstrate professional and ethical behavior? 3. Demonstrate a working knowledge of teaching and learning principles? 4. Demonstrate the ability to assess the visual environment, provide appropriate environmental adaptations, and the use of environmental cues for using vision? 5. Demonstrate an ability to interpret assessment data provided by professionals from a variety of disciplines? 6. Demonstrate the ability to understand and utilize information from the clinical low vision examination? 7. Demonstrate the ability to administer vision assessments and interpret results appropriately? 8. Demonstrate the ability to assess and evaluate learners’ needs and abilities in a variety of environments? 9. Demonstrate the ability to assess the learners’ effective use of low vision devices? 10. Demonstrate the ability to plan appropriate goals for enhancing visual functioning with and without optical devices? 11. Demonstrate the ability to select, design, and implement a sequential instructional plan? 12. Demonstrate a working knowledge of the effects of disabling co-morbidities?
If the CLVT applicant has completed the required clinical practice (350 hours) at more than one agency/clinic, please list the additional agencies/clinics: (Name of agencies/clinics, addresses, phone numbers, dates of practice). DIRECTIONS: For each competency listed below, please indicate whether the applicant passed or did not pass. All competencies require a rating and all competencies must be passed for the applicant to sit for the CLVT examination. Competencies: Did the applicant… Pass Fail Comments 1. Demonstrate appropriate interpersonal relationships and the ability to work closely with colleagues and community professionals as a member of the interdisciplinary low vision team including OD/MD ? 2. Demonstrate professional and ethical behavior? 3. Demonstrate a working knowledge of teaching and learning principles? 4. Demonstrate the ability to assess the visual environment, provide appropriate environmental adaptations, and the use of environmental cues for using vision? 5. Demonstrate an ability to interpret assessment data provided by professionals from a variety of disciplines? 6. Demonstrate the ability to understand and utilize information from the clinical low vision examination? 7. Demonstrate the ability to administer vision assessments and interpret results appropriately? 8. Demonstrate the ability to assess and evaluate learners’ needs and abilities in a variety of environments? 9. Demonstrate the ability to assess the learners’ effective use of low vision devices? 10. Demonstrate the ability to plan appropriate goals for enhancing visual functioning with and without optical devices? 11. Demonstrate the ability to select, design, and implement a sequential instructional plan? 12. Demonstrate a working knowledge of the effects of disabling co-morbidities?
APPENDIX%20A%20CLVT-Clinical%20Competency%20Evaluation%20Form-2015.docx