New Jersey Division of Consumer Affairs

Congratulations!

You have completed the Online Orientation.

Please complete the
Orientation Verification Form
below to alert the Committee that you have satisfied this requirement.

Thank you!



Orientation Verification Form

□ = Required Field

△ = Required Field If You Hold an:
Occupational Therapist License   or  Occupational Therapist Assistant License.

□ Full Name:
□ Email Address:
□ Phone Number:
(ex: 9995551111)


△ License Number: