ORTHOPEDIC MANUAL THERAPY FELLOWSHIPBecome a TRULY Evidence-Based PracticionerA MAPS Fellowship education is truly evidence-based, incorporating all 3 EQUALLY WEIGHTED aspects of EBM: • Advanced Patient-Centered Clinical Expertise • Clinical Expertise through Professional Excellence • Cutting Edge Evidence-Based Clinical Research

Earn International Recognition: Highest Level of Clinical ExcellenceThe MAPS Fellowship is APTA accredited through the American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE), and as such, graduates will qualify for acceptance into the American Academy of Orthopedic Manual Physical Therapists (AAOMPT). Fellows of AAOMPT are recognized worldwide by both the APTA and the International Federation of Orthopedic Manipulative Therapists (IFOMPT) as having achieved the highest level of clinical excellence in Orthopedic Manual Therapy.

Hands-on 1:1 Mentorship with Respected Expert Faculty• A unique combination of online, live, and multiple 1:1 clinical mentorship sites available throughout the U.S.• Faculty includes: 15 FAAOMPTs, 16 OCSs, 13 PhD/DPTs, and 7 Advanced Manipulation degrees.• Over 540 combined years of clinical expertise.• Faculty contributions to over 185 peer-reviewed journal articles. Flexible scheduling to fit your busy lifestyle • Take from 12 to 36 months to complete and pay for the program.• Limited time away from your home clinic.

Earn your COMT simultaneously with your Fellowship • Earn your COMT as the first component of the Fellowship program via direct contact weekend courses offered throughout the United States. • Fellows in Training receive 20% off all MAPS courses. • COMTs who earn and maintain their Fellowship will be exempt from COMT recertification requirements.

MAPS • www.ozpt.com • PO Box 1244 Cutchogue, NY 11935 • 1-800-828-0738

To Learn More About the MAPS Fellowship: Submit the Fellowship Information Request Form (on back)

Limited Fellowship Positions Available —

Applications Now Being Accepted for Spring 2018 Enrollment

             

Information Request: MAPS Fellowship Program in Orthopedic Manual Therapy Through December 31, 2017, eligible applicants MUST have a valid PT license, at least 2 years clinical outpatient experience (with at least 1 year in orthopedics) AND meet at least one of the following criteria: 

An Orthopedic Certified Specialist (OCS) designation  Be a graduate of an APTA credentialed Orthopedic Residency Program 

Note: ABPTRFE rule changes scheduled to become effective January 1, 2018 requires fellowship candidates to have either their OCS or a certificate of completion from an accredited orthopedic residency program. 

 PERSONAL CONTACT INFORMATION Name:____________________________________________E‐mail: ____________________________   Phone: ________________________________Alternate phone:  _______________________________ Mailing address:______________________________________________________________________ ____________________________________________________________________________________  PROFESSIONAL INFORMATION Educational designations (e.g., PT, DPT, PhD, DO, etc.):_______________________________________ Additional professional certifications (e.g. COMT): ___________________________________________ Number of years practicing PT:____States in which you are a licensed PT: ________________________ MAPS courses successfully completed (to date):_____________________________________________  CURRENT EMPLOYMENT: Name of Company/Clinic:_______________________________________________________________ Address of Company/Clinic: _____________________________________________________________ ____________________________________________________________________________________ Phone: ____________________  Fax: ___________________ E‐mail:____________________________  EMPLOYMENT AND EDUCATION HISTORY Please include a copy of your most recent resume/CV, including any continuing education courses you have taken in the last five years. INFORMATION DISCLOSURE AGREEMENT: I attest that the information provided on this form is truthful.  I also understand that any information provided to me from MAPS and/or the MAPS Fellowship Program is confidential protected information, which may not be disseminated to any third party without advance written permission and/or approval of MAPS.  I further agree not to share the information received from the MAPS Fellowship Program and/or its curriculum with any third parties, with the exception of my personal financial or legal counsel and my immediate family members.  The information received may be shared with my employer only for the purpose of obtaining approval or consent to apply to the Program or to be reimbursed for participation in the Program. 

X____________________________________________________________     Date: ________________ Your Signature  

Email form to Meghan@ozpt.com, fax to 631‐298‐3810/5872 or mail to MAPS, PO Box 1244, Cutchogue, NY  11935      www.ozpt.com     Tel: 1‐800‐828‐0738