P1E Form PDF Details

Navigating the process of becoming a licensed physical therapist or physical therapist assistant in California involves a crucial step: completing and submitting the P1E form. This form is essential for graduates of Commission on Accreditation in Physical Therapy Education (CAPTE) accredited entry-level physical therapy (PT) or physical therapist assistant (PTA) programs. It's important to note that transitional and post-professional PT programs, which do not hold CAPTE accreditation, fall outside this requirement. The State of California mandates the form to be filled out by the college registrar or program director, certifying the completion of required academic coursework and clinical internships as dictated by sections 2650 and 2655.9 of the California Business and Professions Code. The Physical Therapy Board of California underscores the necessity for the Certificate of Completion to arrive in an officially sealed school envelope, ensuring the document's authenticity and that it has remained unopened by the applicant. Fail to adhere to this directive, and the licensure application faces rejection. Thus, the form not only serves as a testament to one’s academic and practical training achievements but also acts as a gatekeeper in the professional journey of aspiring physical therapists and assistants in California.

QuestionAnswer
Form NameP1E Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesaffixed, p1e, EDMUND, 2005

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BUSINESS, CONSUMER SERVICES, AND HOUSING AGENCY – GOVERNOR EDMUND G. BROWN JR.

Physical Therapy Board of California

2005 Evergreen St. Suite 1350, Sacramento, California 95815

Phone: (916) 561-8200 Fax: (916) 263-2560

Internet: www.ptbc.ca.gov

＃

CERTIFICATE OF COMPLETION

For graduates of CAPTE accredited entry level PT or PTA programs ONLY

Please note that transitional and post-professional PT programs are NOT accredited programs

The Physical Therapy Board of California (PTBC) must receive the Certificate of Completion with the application for licensure in an officially sealed school envelope sealed by the registrar or program director completing this form. This is to assure that the Certificate of Completion came from the school and was not opened by the applicant. Submitting an application without a properly sealed Certificate of Completion will cause your application to be denied.

This form is to be completed in its entirety and signed by the College Registrar or Program Director of the degree-granting program to document completion and graduation of a professional degree program accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE). The entry level

PT/PTA program completed must have also included academic coursework and clinical internship pursuant to sections 2650 and 2655.9 of the California Business and Professions Code.

Type of Program Completed:

□ Physical Therapist (PT) □ Physical Therapist Assistant (PTA)

For PT graduates ONLY: Was the program completed a transitional and/or post-professional PT program?

□ YES* □ NO

* If yes, please note transitional and/or post-professional PT programs are not accredited programs.

This certifies _____________________ _____________________

________________________

FIRST NAME

LAST NAME

OTHER LAST NAMES USED

Completed all coursework and clinical practice on:

________________________________

 

 

DATE

Graduated on or is a candidate for graduation on:

________________________________

DATE

Received the following degree: __________________________________________________

NAME OF DEGREE OBTAINED

From: ______________________________________________________________________

NAME OF ACADEMIC INSTITUTION THAT GRANTED THE DEGREE (MUST BE A CAPTE ACCREDITED PROGRAM)

Signed and the college seal affixed this ____________ day of _____________, ____________.

MONTH YEAR

I swear under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

_________________________________________________

SIGNATURE OF REGISTRAR OR PROGRAM DIRECTOR

__________________________________________________

[SEAL]

TYPE or PRINT your name and title

AFFIX SCHOOL SEAL HERE

P1E

Form Revised 01/2011

How to Edit P1E Form Online for Free

Through the online PDF editor by FormsPal, you may complete or change affixed right here. Our development team is constantly working to improve the editor and make it even easier for people with its many features. Take your experience to a higher level with continually developing and amazing opportunities we offer! To get the ball rolling, consider these basic steps:

Step 1: Firstly, access the pdf tool by clicking the "Get Form Button" at the top of this webpage.

Step 2: As soon as you open the file editor, you will see the document made ready to be completed. In addition to filling out various blanks, you can also do other sorts of things with the Document, including putting on any textual content, changing the initial textual content, adding images, signing the PDF, and a lot more.

To be able to finalize this form, be sure to provide the required information in every single blank field:

1. It is crucial to fill out the affixed properly, thus be attentive while working with the parts comprising these specific blanks:

Stage no. 1 for filling out licensure

2. Once your current task is complete, take the next step – fill out all of these fields - The Physical Therapy Board of, Physical Therapist PT Physical, Type of Program Completed, For PT graduates ONLY Was the, YES NO, If yes please note transitional, OTHER LAST NAMES USED, FIRST NAME, LAST NAME, DATE, Graduated on or is a candidate for, DATE, From, NAME OF ACADEMIC INSTITUTION THAT, and NAME OF DEGREE OBTAINED with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

licensure writing process shown (portion 2)

3. This next section will be about From, NAME OF ACADEMIC INSTITUTION THAT, Signed and the college seal, MONTH, YEAR, SIGNATURE OF REGISTRAR OR PROGRAM, TYPE or PRINT your name and title, SEAL, AFFIX SCHOOL SEAL HERE, and PE Form Revised - type in every one of these blanks.

Stage # 3 of filling out licensure

Be really mindful while filling in AFFIX SCHOOL SEAL HERE and TYPE or PRINT your name and title, since this is where a lot of people make mistakes.

Step 3: Reread all the details you've inserted in the blanks and then click the "Done" button. Right after registering a7-day free trial account with us, you will be able to download affixed or send it through email at once. The document will also be available from your personal account page with your each modification. When using FormsPal, you can certainly fill out forms without having to get worried about information incidents or records getting shared. Our protected software ensures that your private information is stored safe.

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