Doctoral Forms

Capstone Preparation Part II

Introduction to Capstone Preparation

This is the first part of a two-part form used to guide the student and the doctoral mentor in the development of the 14-
week Capstone experience and project. Beginning in the spring semester of the second year of the doctoral program,
the student begins the process of developing their Capstone with guidance from their faculty mentor and capstone
coordinator, as needed. Based on the student’s career goals, interests and learning needs, the student proposes a 14-
week immersive experience to gain knowledge and skill in one or more specific areas of focus: occupational therapy
practice, research, administration, leadership, program and policy development, advocacy, education or theory
development

The purpose of the Capstone Preparation Part I Form is to guide the student through the initial exploration phase of
Capstone preparation. The student will complete a literature review as they research potential options, and identify
their area(s) of focus for the Capstone. Once the student has received approval from their faculty mentor on the Lit
Review and Part I form, they may begin work on the Capstone Professional Needs Assessment and Part II form.

The purpose of Part II of the Capstone Preparation form is to solidify plans for the Capstone experience and project, and
to provide the necessary information for a contract with the site mentor to be established. In order to complete this
portion of the form, the student reports on the completed needs assessment, discusses the project and experience
options with their faculty mentor, and outlines the Capstone experience. The student’s site mentor agreement and
contact information for the site mentor must be included in the Part II submission so that an affiliation agreement can
be established prior to the experience.

Due Dates

Document Due Date

Graded Capstone Prep Lit Review with Rubric
Capstone Preparation Part I July 1, 2021

Capstone Prep Part I Form signed by Faculty

Mentor

Professional Needs Assessment with Rubric

(incorporates updated Lit Review)

Capstone Preparation Part II Domestic Experiences:

Signed copy of Site Mentor agreement (one November 19, 2021
for each mentor)

CV, résumé or expertise verification form for

each mentor

Capstone Preparation Part II Form

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Part 2: Final Capstone Proposal

Prior to finalizing this form the student must:

 Update the Literature Review from Part I and incorporate into the Professional Needs Assessment
 Submit the Professional Needs Assessment Report to their Faculty Mentor for approval
 Draft Learning objectives for the proposed Capstone Experience and Project and share with prospective site
mentors
 Obtain the signed agreement from a Site Mentor with CV, resume, or expertise verification form
PLEASE NOTE: Documentation of mentor expertise is required prior to the Capstone Experience and is subject
to approval by the AFWCC (ACOTE 2018, Standard D.1.6)

Once a Site Mentor has reviewed and accepted the proposed Capstone Learning Plan Objectives, the student may
complete the Capstone Preparation Part II Form and obtain signatures from the Site Mentor and Faculty Mentor. The
AFWCC will review and sign the submitted documentation and provide approval for the Fieldwork Administrative
Coordinator to initiate the contract process with the mentor’s site. 

Please Note: Submission of this form does not guarantee the placement. Confirmed placement is subject to
contractual agreement with the site. If a contractual agreement cannot be reached, the AFWCC will work closely with
the Faculty Mentor and Student to identify an alternate site that offers a comparable experience aligned with the
student’s goals and objectives.

Executive Summary: Provide a brief (2 paragraph max) summary of your updated literature review, findings from
the Professional Needs Assessment, and revised/updated purpose statement for your proposed Capstone.

The purpose of this proposed DEC is to collaborate with a business owner on how to start a private practice that
provides occupational therapy services through a telehealth service model. I would like to create a quick guide for
new students interested in starting a private practice.

Project Significance: Articulate a brief statement that highlights the importance of your proposed project. Include
elements of significance for both your proposed site mentor/facility, as well as any potential significance for a more
general population or audience. Include a brief statement of how your proposed capstone will help you to work
towards your career goals.

This doctoral experience is of the upmost importance because I do want to start my own private practice that
provides occupational therapy services via telehealth. This doctoral experience is significant for my proposed
mentor because I will be able to assist with creating videos to improve the efficiency of training new therapist while
also learning about the administrative side of running a business. This tools will allow me to provide a rich, evidence-
based approach towards developing my capstone and my future business.

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Mentor(s) for the Capstone Experience

Include only those with firm commitment. If the Capstone will include more than one site/mentor, list dates for each
and identify specific learning objectives and evidence of learning affiliated with each. You must have a signed
mentorship agreement and objectives that pertain to that mentor for each mentor you have listed.

Please note: approval of more than one affiliation agreement for the Capstone experience is at the discretion of the
Capstone Coordinator and must be justified by clear, specific objectives for each site, and/or rationale for why the
additional site is necessary.

ACOTE accreditation requires that we document the skills, knowledge and role of the site mentor, and that the expertise
of the site mentor be directly related to the student’s objectives for the Capstone (Standard D. 1.6). The student is
required to submit a résumé or CV for each mentor in the Capstone Canvas site with this proposal. The Expertise
Verification Form can be used in lieu of a CV or résumé if needed. Expertise of the proposed mentor is subject to
evaluation by the Faculty Mentor and Capstone Coordinator prior to approval.

Site Mentor and direct
contact information
(MUST include email
address)
Andrea Sims
andi@growtherapynv.com
Site name, address, phone
Grow Therapy NV
5940 S Rainbow Blvd #4000,
Las Vegas, NV 89118
Dates of experience
April – Aug 2022
Brief description of Site
Mentor expertise
related to proposed
objectives
Grow Therapy NV was
founded by Andi Sims
MA, CCC-SLP in
November, 2018. Andi
received her master’s
degree in Speech-
Language Pathology
from the University of
Pittsburgh in 2013. After
completing her program,
Andi decided to move to
the west coast where
she started her career
working for Clark County
School District in the
autism programs. Since
then, Andi has worked in
a variety of settings
including long term care
facilities for kids,
outpatient clinics, early
intervention, skilled

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nursing facilities,
hospitals and home
health. Andi specializes
in working with feeding
and swallowing
disorders, language
delays, articulation,
fluency, phonological
disorders, memory,
social skills, aphasia,
autism, AAC and brain
injuries. Andi’s passion
for feeding disorders has
resulted in opportunities
to guest lecture and
train other professionals
on the topic of pediatric
feeding and swallowing
disorders at local
colleges and universities.
Andi is licensed to
practice in the state of
Nevada and holds the
Certificate of Clinical
Competency from the
American Speech-
Language and Hearing
Association (ASHA).

If you have proposed more than one Site Mentor, submit the following documentation for EACH mentor:

- Signed Mentor Agreement

- Draft of Learning Objectives specific to the mentor
- Documentation of Expertise (CV, résumé, expertise verification form)

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Mentorship Agreement: Roles and Responsibilities

The responsibilities described below outline the roles of all involved in the completion of the student’s Capstone
proposal, project, and experience. These responsibilities are defined in an effort to provide clarity for mentorship, and
allow for all parties to acknowledge the terms of the Mentorship Agreement established for the student’s capstone. Any
changes or modifications to the below roles and responsibilities should be articulated in writing, and agreed upon by all
parties. Changes or modifications are subject to the minimum standards outlined by ACOTE (see link below).

The Capstone is built on a model of mentorship that helps the student to advance their knowledge and skills in a
particular area of interest beyond that of an entry level occupational therapy clinician. Mentoring can be defined as,
“the relationship between two people in which one person (the mentor) is dedicated to the personal and professional
growth of another (the mentee). The mentor has more knowledge and experience than the mentee” (ACOTE, 2011). See
the following link to review the current ACOTE Standards (2018) that address the Doctoral Capstone, effective July 1,
2020:

www.aota.org/~/media/Corporate/Files/EducationCareers/Accredit/StandardsReview/2018-ACOTE-Standards-
Interpretive-Guide.pdf

Responsibilities of the OTD Student:

The student’s successful completion of the capstone experience and project is assessed through the completion of the
student’s Personal Learning Plan. It is the responsibility of the student to:

 Identify an area of focus for their Capstone experience and capstone project. (Standard D. 1.0).
 Complete capstone preparatory work that informs the nature and scope of the Capstone experience and
project, including a review of the current literature and a needs assessment pertaining to the topic area of
interest (Standard D. 1.3).
 Select a site mentor with expertise and experience that align with the student’s goals, who can support their
growth in their chosen area of focus (Standard D. 1.6)
 Facilitate the completion of all necessary paperwork to establish an affiliation with the Site Mentor (Standard D.
1.4).
 Work with the Faculty Mentor and Site Mentor to develop the specific objectives, learning activities, and
deliverables that will serve as evidence of the student’s learning during the Capstone (Standard D. 1.7).
 Provide regular updates of progress on Learning Plan objectives to the Site Mentor and to the Faculty Mentor
upon request (Standard D. 1.8).
 Engage in capstone related activities for the required 560 hours of mentored Capstone experiential time, with
no more than 20% of capstone hours completed off-site. The student will maintain a log of their capstone hours
and obtain verification of hours from their Site Mentor (Standard D. 1.5).
 Plan and execute a formal means of dissemination of information regarding the Capstone project that includes a
synthesis of in-depth information pertaining to the student’s focus area and topic of interest (Standard D. 1.9).

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 Demonstrate professional growth through in-depth self-reflection regarding the extent to which learning
objectives were achieved, and their impact on the student’s personal and professional development (Standard
D. 1.2).
 Demonstrate professional behaviors consistent with the OT Code of Ethics and indicative of a doctoral level
professional as assessed by the student’s Site Mentor (Standard D. 1.2).

Responsibilities of the Site Mentor:

The Site Mentor has experience, knowledge, and skills specific to the student’s areas of interest, identified learning
objectives, and area(s) of focus for the Capstone experience and proposed project. The site mentor will provide
guidance to the student as they complete their Capstone requirements, and evaluate the student based on professional
development and ability to execute their Personal Learning Plan effectively. It is the responsibility of the Site Mentor to:

 Provide evidence of specific expertise and experience related to the student’s area of focus and learning
objectives (Standard D. 1.6).
 Share wisdom, information, advice, guidance and emotional support throughout the Capstone experience as the
student strives to execute their Personal Learning Plan (Standard D. 1.6, D. 1.8).
 Be available for the student during the Capstone experience, and serve as the student’s primary point of contact
for the site (Standard D. 1.6)
 Provides access to the site according to a predetermined work schedule established with the student (Standard
D. 1.5)
 Provide experiences at the site that facilitate the student’s ability to reach personal and professional goals
outlined in the Learning Plan (Standard D. 1.5, D.1.8)
 Meet regularly with the student to shape professional behavior related to role and area of focus, assess capacity
and provide guidance to initiate and complete work as proposed, approve completed hours and activities, and
monitor for any concerns related to accomplishing Personal Learning Plan objectives (Standard D. 1.2, D. 1.5, D.
1.7)
 Communicate any concerns, questions or feedback regarding the student’s performance with the student and
the faculty mentor and/or capstone coordinator when necessary. The Site Mentor evaluates the student’s
performance in terms of professional behavior and ability to accomplish the objectives in the Learning Plan (D.
1.2, D. 1.8).

Responsibilities of the Faculty Mentor:

The Faculty Mentor advises the student throughout the capstone planning process, and provides ongoing guidance and
consultation throughout the capstone experience and project. The Faculty Mentor will assist the AFWCC in evaluating
the student’s ability to synthesize in-depth knowledge during through the capstone project.

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Responsibilities of the Capstone Coordinator:

 Maintain regular contact with the student via email, meetings and phone calls to ensure student learning
objectives and deliverables are feasible and work can be accomplished within the scope and timeline established
(D. 1.5, D. 1.8)
 Collaborate with the site mentor and student to ensure that the experience is consistent with the values and
curricular objectives of the OTD program (D. 1.2).
 Advise the student during the capstone planning process, guide mentored studies, and provide feedback on the
quality and scope of student work as needed (D. 1.3, D. 1.5, D. 1.8)
 Communicate with the Site Mentor when needed to facilitate professional development and student’s ability to
accomplish objectives and activities as outlined in the student’s Personal Learning Plan (D. 1.2, D. 1.5, D. 1.8)
 Evaluate the student’s performance based on the execution of the Learning Plan, the level of in-depth synthesis
of knowledge demonstrated by the student during project dissemination, and the quality of Capstone Project
work submitted and disseminated at the conclusion of the Capstone experience (Standard D. 1.2, D.1.8)
 Ensure that sites supporting an OTD student during the Capstone have a current Fieldwork Site Affiliation
Agreement, AOTA Data Sheet, and mentorship agreement (D4 and D6 forms) on file prior to the start of the
Capstone Experience (Standard D. 1.4).
 Collaborate and consult with the student and faculty mentor during the Capstone planning process to facilitate
and oversee the student’s timely selection of an area of focus, completion of preparatory activities, and
selection of a site mentor who is able to support the student’s capstone project and experience (Standard D.
1.3)
 Provide ongoing support and education to Site Mentors as needed in order to assist with student’s professional
growth and ability to accomplish proposed work (Standard D. 1.2, D. 1.5, D. 1.8).
 Serve as a point of contact to the Site Mentors for the University outside the OTD Student mentorship
relationship (Standard D. 1.4, D. 1.5)
 Oversee administration of the Capstone experience placements and completion of all capstone requirements,
including maintaining and storing related agreements, paperwork, documentation of expertise for mentors
(Standard D. 1.3, D. 1.4, D. 1.5, D. 1.6, D. 1.7, D. 1.8).
 Facilitate coordination and communication between the Clinical Site Mentor, Student, and Faculty Mentor as
needed.
 Assist with remediation of student performance in conjunction with the student and mentors, as needed
(Standard D. 1.5).

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Proposed Capstone Professional Learning Plan Objectives

(if more than one site/mentor, include a separate list of objectives and agreement for each)

Student Name: Yosef Bruer

Proposed Site Mentor: Andrea Sims

Proposed Site and Location: Grow Therapy NV

Student’s Professional Mission Statement:

My mission is to learn about starting a private practice that provides/provided occupational therapy services via a telehealth
service delivery model to ensure that I am aware of how to start my own company in the future. I would also like to provide a
quick guide on starting a private telehealth OT practice.

Learning Objective Learning Activities to Outcome Measure Timeline for Completion

Meet Objectives
(What you hope to learn) (What you will produce (When will this outcome
(What you will do to achieve as evidence of achieving measure be
learning objective) learning objective) completed?)

1. Demonstrate steps to 1a. Read and reflect upon Evidence based research By the end of week 4
start a private books of books related to the
practice/build topic
connection to expand 1b. Meet with content experts
a professional Writing reflections
1c. Apply knowledge gained to
network while
update CV, e-portfolio and
marketing myself Update promotional
other electronic business
platforms materials (resume, e-
portfolio, linked in)

4. Interpret billing 2a. Observe and potentially Investigate Complete by the end of
methods, CPT codes, participate in facets of billing new/available funding week 6
insurance companies, process sources
HIPAA, referrals, how
2b. Research grant and funding Create an outline of

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to charge, getting types for starting a business billing best practices for
started. telehealth line of service
2c. Research and potentially
participate in online
educational courses

7. Explore about the 3a. Explore how telehealth Completion of a one- Before the end of week
specifics with sessions were implemented. pager or a matrix 7/8
provided telehealth detailing/provided
OT services, 3b. Understand how to plan telehealth OT service,
pros/cons, billing and execute sessions through pros/cons, billing
methods, and webinars, content experts, and methods, and
laws/regulations and others laws/regulations and
overall strategy used overall strategy used to
3c. Review policies and
to remain fiscally remain fiscally
procedures in place along with
responsible. Identify responsible
the legal requirements
what’s involved in
the day-to-day
business operations

Learning Objective Learning Activities to Outcome Measure Timeline for Completion

Meet Objectives
(What you hope to learn) (What you will produce (When will this outcome
(What you will do to achieve as evidence of achieving measure be
learning objective) learning objective) completed?)

10. Apply learned 4a. Create marketing materials Completed marketing Before end of week 8 /9
marketing/promotion materials for telehealth
services through 4b. Evaluate existing marketing audience
demonstration of strategies and efforts of Grow
creating a Therapy NV Deliverable of social
wraparound service media marketing
4c. Create, assist, analyze and suggestions
within the existing
update marketing and/or
framework of the
promotional project withing
company
the company

13. Create administrative 5a. Additional literature search Completion of Before the end of Week

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training videos that 5b. Identify and analyze administrative videos 10

will enhance my training videos scripts and
knowledge of the components to successful
administrative side of completion
Completion of write-up
running a private
5c. Use of evidence-based outlining the goals and
practice and how to
information given in the videos delivery methods of
think like a business
training videos
owner

16. Create a quick guide 6a. Specify my target market Quick guide that Before the completion
through my capstone and service delivery based on highlights the important of my capstone in
project that will market analysis and needs steps of starting a August
highlight the assessment private telehealth OT
important steps to practice
starting a private 6b. Identify components of my
practice that provides business plan (mission, vision, Create a “starters
OT services via funding mech, marketing plan, guide/how to” on
telehealth. etc) starting a private
Demonstrate an practice that provides
6c. Develop the content and OT services via
understanding of
materials to produce a guide telehealth
best practices, needs,
and evidence based
interventions

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Student Name: Yosef Bilal Bruer

Capstone Site: Grow Therapy NV

Title of Capstone Project: Quick Guide to Starting a Private Practice that Provides Occupational Therapy Services via
Telehealth

APPROVAL SIGNATURES

I have reviewed and discussed the above Capstone Plan with the student and the student’s Mentors. I understand my
role and responsibilities in supporting the student in completing the activities and evidence of learning as outlined
above. If at any time I have concerns about my ability to support the student in the above learning objectives, I
understand it is my responsibility to initiate a revision of the above activities and objectives accordingly. Revisions to the
above plan must be approved by all parties below. The student is responsible for coordinating approval and submitting
documentation of any approved modifications.

OTD Faculty Mentor: ______________________________________________ Date: _______________

Site Mentor: ______________________________________________________ Date: _______________

Capstone Coordinator: ______________________________________________ Date: ______________

Student Acknowledgement:
I have reviewed and discussed the above Capstone Plan with my mentors. I understand my role and responsibilities in
completing the activities and evidence of learning as outlined above. I understand that successful completion of the
Capstone requirement is based on the quality of the evidence of learning described in this Learning Plan. If at any time I
have concerns about my ability to complete the learning plan as outlined, I understand it is my responsibility to initiate a
revision of the above activities and objectives accordingly. Revisions to the above plan must be approved by all parties
above. I understand I am responsible for coordinating approval and submitting documentation of any approved
modifications in a timely manner. I also understand that my mentors and Capstone Coordinator have the right to initiate
changes to this plan or to mandate remediation of this plan in the event progress is insufficient to meet the standards of
the Capstone.

Student: _______________________________________________________ Date: ____ ___________

Student Printed Name: ______Yosef Bilal Bruer___________________________________________________________

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