Levels OPT™ Specialist Application Name(Required) First Last Email(Required) PhoneOrganization/Therapy Practice NameAddress(Required) City State / Province / Region AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country What is your profession?Are you a Level 3 OPT Specialist and interested in pursuing Level 4 Advanced Specialist Training? Yes No LEVEL 1 -- LEARNING OPT™Requirements: Complete LEVEL 1 coursework + 6 months (minimum) applied or observed OPT techniques in your practice (depending upon your professional role on your team) within 3 years of application.LEVEL 1 course requirements: please select the courses you have completed (if you have not taken these courses, leave unchecked) 3-Part Treatment Plan for OPT™ (Oral Placement Therapy) -- the foundations for OPT OPT™ Assessment and Treatment Plan -- once you've learned the fundamentals in 3-Part Treatment Plan for OPT, it's time to begin building your preliminary OPT Plans Provide LEVEL 1 course names completed and dates of completionVerify that you have met Level 1 requirements (False verification may result in automatic expulsion from this training program(Required) Yes, I verify that I HAVE COMPLETED Level 1 course requirements and have applied the OPT techniques for at least 3 months No, I HAVE NOT COMPLETED Level 1 requirements but I'm planning to this year No, I have not met Level 1 requirements LEVEL 2 -- EXPANDING YOUR OPT™ KNOWLEDGE AND PRACTICERequirements: Complete LEVEL 1 coursework + 3 months (minimum) applied or observed OPT techniques in your practice (depending upon your professional role on your team). Also required: completion of at least one of our core courses + completion of at least 6 additional hours of TalkTools coursesLEVEL 2 CORE COURSES: Have you taken at least ONE of the following courses? Navigating the Feeding Journey (Feeding Therapy: A Sensory Motor Approach) Superpowers of the Sensory System Motor Speech Disorders OR Sensory Motor Approach to Apraxia Kaleidoscope Model for Feeding Assessment and Remediation of Tethered Oral Tissues Taking Your Clients with Autism from Non-Vocal to Verbal Provide CORE COURSE names completed and dates of completionVerify that you have met Level 2 requirements (False verification may result in automatic expulsion from this training program(Required) Yes, I verify that I have completed Level 2 course requirements and have applied the OPT techniques for at least 3 months No, I have not met Level 2 requirements but I'm planning to this year No, I have not met Level 2 requirements LEVEL 4 -- ADVANCED OPT™ SPECIALIST TRAININGRequirements: Level 3 certification; 1 year direct application or immersive observation of OPT™ techniques in your practice or as part of your speech and feeding team (depending upon your role)What was the start date of your Level 3 TrainingMonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20202021202220232024202520262027202820292030What was the end date of your Level 3 TrainingMonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20202021202220232024202520262027202820292030ADDITIONAL COMMENTSAny additional information you would like to add?
