Follow These 8 Steps to Become a COTA

Occupational therapy is an exciting and fast-growing field. The role of the Certified Occupational Therapy Assistant, or COTA, is expanding as well.

In fact, some estimates predict COTA positions are projected to grow faster than the average of all combined occupations, with a rate of 25 percent from 2021 to 2031 (Bureau of Labor Statistics), with more COTA positions opening up over the next 10 years. This shows us that there may be thousands of new jobs available to occupational therapy assistants who are licensed and certified to practice occupational therapy.

The question arises, though, how do you become a COTA?

As a COTA myself, I’ll show you the way. Below are the 8 steps to take to become a Certified Occupational Therapy Assistant.

1. Learn About Occupational Therapy

The first important step to becoming a COTA is learning about the field of occupational therapy. If you are reading this, you have at least heard about occupational therapy to some extent and are seriously considering choosing this career path.

You may have already seen the incredible benefit that can come from the diligent work of an OT practitioner. Perhaps you or a loved one have been through the occupational therapy process and saw its benefits with your own eyes.

Or maybe someone noticed your optimistic, problem solving attitude and told you that occupational therapy would be good fit for you.

Whatever your current exposure to occupational therapy may be, keep learning more! With such a broad spectrum of settings to work in, try to envision yourself working in each area – with children, in a hospital, in an outpatient clinic, in a school, in a skilled nursing facility and much more.

Although you will not need to love working in every field, it will be important that you keep an open mind as you go through your schooling and find what fits best for you.

Reading articles, like this one, on what exactly OT is and hearing what others say about OT will whet your appetite for step two in the process.

2. Get OT Observation Hours

Reading and researching what occupational therapy is and how it works is an essential step toward pursuing a career in OT. As beneficial as it is to read and talk about occupational therapy, nothing can replace seeing it in action.

Some OTA schools require observation hours to be logged and tracked to make sure that students coming into the COTA program have a full understanding of what is involved in working in the field.

Even if a school does not require observation hours for admission into the program, having this under your belt will make you a more outstanding applicant and, more importantly, better prepare you to enter the field.

The time you spend observing the OT process should not just be idle. While watching experienced, licensed therapists doing their job, put yourself in their shoes. Do you think you could become comfortable doing what they do? Would you enjoy it? What challenges do you think you will face?

Also, be sure to observe a variety of OT settings and populations. Because occupational therapy can help such a large group of people, the visible portion of the therapy process can look very different.

The important thing to understand is that all occupational therapy has the same focus – helping people engage in their meaningful occupations, what they want and need to do.

3. Complete Prerequisite Coursework

Before being admitted into the Occupational Therapy Assistant program at your college of choice, you will first have to take a few courses to help you have a basic understanding of key concepts.

For example, anatomy and physiology are essential to our jobs as COTAs, so taking these courses before studying occupational therapy is generally required.

Every single person you work with in occupational therapy will have some psychological trauma, regardless of their diagnosis. Even though we are not psychotherapists, we need to understand on at least a basic level what is going on behind the scenes in their head.

Basic, general curriculum courses, such as written communications and mathematics, are also usually required.

Although math and essay writing will not be used extensively, there may be times that the principles explained may come up. Taking goniometric measurements (measuring the angles of joint range of motion) and assessing wheelchair fit can require some confusing math problems in school.

Daily documentation must be neat, easily understood, and grammatically correct, which takes fluency in English. More specific coursework may be required by your school, so be sure to check with each program you’re considering.

Some schools have other requirements as well, such as attending an open house or having a log of the observation hours mentioned above.

4. Apply to an Accredited OTA Program

Now that you have decided that occupational therapy is the job for you, you’ve completed your observation hours in the field, and you’ve completed all of your observation hours, it’s time for you to apply for a program.

This can be a difficult process, but thankfully the ACOTE has made it a little easier for you.

The ACOTE, or Accreditation Council for Occupational Therapy Education, is the governing body that determines what must be included in an OT or OTA program in order to provide the basic information needed to equip occupational therapists and occupational therapy assistants to enter the workforce.

If a school has not been accredited by ACOTE, it will likely not prepare you the way you need and you will not be permitted to take the licensure exam.

Not all ACOTE accredited schools are the same, though. The length of the program, the personalities of the educators, and the physical location of the school will all have a bearing on what you choose.

When considering a school, don’t just pick the closest school and only talk to the staff there. Instead, consider talking to the managers and directors of nearby therapy departments or graduates from that and other nearby schools.

Remember, not everyone has the same expectations out of an OTA program, so try to find the real reason people like or dislike a certain program. It may simply be that they had a personality conflict with an instructor.

Occupational therapy assistant school will likely be one of the most challenging things you have done. With so much to learn in such a relatively short time, much of your time will be jam-packed with information.

In addition, many instructors try to teach you skills you will need to have in the field – time management, multitasking, and collaboration, to name a few – by exposing you to situations that require it.

5. Complete Fieldwork

Level I Fieldwork

Every accredited occupational therapy program must include internships, known as fieldwork. There are two levels of fieldwork, level I and level II.

A level I fieldwork rotation focuses more on observation in the field. Although many students have already done some kind of observation hours prior to entering the program, this fieldwork is designed to help put the principles learned in the classroom into the real world.

Having this opportunity to see clinicians applying the techniques that were just discussed in class can really help to solidify these ideas in your head. The level I rotation is much shorter, only a few days long, and earlier in the program.

Level II Fieldwork

A level II fieldwork rotation has more of a focus of implementing the techniques learned in class. This fieldwork is completed once the majority of the classwork has been covered and students are almost ready to enter the field.

The level II fieldwork rotations give students a chance to gain hands-on experience in developing treatment ideas and working in a real-world setting while having a “safety net” in their clinical supervisor.

At the same time, it allows them to learn how to balance the textbook therapeutic principles they have learned with realistic expectations – clients that don’t want to participate, complex medical conditions, and adapting on the fly.

Additionally, interpersonal skills, time management, and multitasking will all have to be incorporated into the working environment. A good fieldwork supervisor will gradually ease in a student to possibly handling a full caseload.

6. Pass the NBCOT

After all coursework and fieldwork has been completed, you might be excited to finally get to relax and not worry about taking any more tests.

That isn’t quite the case yet.

The National Board of Certification for Occupational Therapy, or NBCOT, produces a final licensing exam that must be passed in order to apply for state licensure.

There are countless helpful blog posts, study guides and forms of assistance available to help you prepare for the NBCOT. The most important thing to remember, though, is to stay calm.

If you have made it through your accredited OTA program and fieldwork rotations, you should have what it takes to make a success of the NBCOT exam. NBCOT is the organization that provides the certification for a Certified Occupational Therapy Assistant.

7. Apply for your License

Now that you have passed the NBCOT exam, you can follow your state’s procedures for licensure. Every state differs in the exact requirements and process for applying for licensure.

Most states require proof of passing the NBCOT exam, a copy of OTA specific coursework transcripts, and an application fee. Your state may differ in the process required, so be sure to check their detailed requirements.

8. Keep on Learning!

You might think that applying for licensure is the last step to becoming a COTA. In a sense, that is true. The process doesn’t stop there, though.

Certification and licensure both need regular renewals to stay valid. This renewal process usually involves a small fee and proof of continuing education courses.

These courses are essential to providing quality care to those you treat. These courses can be on a variety of subjects, but will typically relate back to your specific treatment setting and clinical interests.


As you can see, becoming a COTA isn’t a quick, simple process. It takes hard work, dedication, and several years of persistence. And even once you have done what it takes to become a COTA, staying licensed, certified, and up to date on the latest standards of best practice can be a bit of a challenge when you’re a new practitioner especially.

At the end of the day, I can say from personal experience, being an Occupational Therapy Assistant is worth all of the effort it takes!

Do you have any questions about becoming an OTA? Ask away in the comments below!

This post was last updated on July 13, 2023.

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  • Camille January 9, 2020   Reply →

    I work full time and will have to while I go to school. Could you estimate how long it would take me to go through this program on a part time class schedule? I have 40 college credits.

    • Sarah Stromsdorfer, OTR/L January 10, 2020   Reply →

      In general, COTA programs are almost always two year long full-time programs. I’m not familiar with part-time COTA programs but would imagine they would take longer than the two year average. Here is a list of accredited COTA programs that might mention on their individual websites if they have part-time options: OTA Associate-Degree-Level Programs – Accredited. I hope this helps!

  • Amy July 5, 2020   Reply →

    Hello! Thank you for this information! I’ve been researching public schools (community colleges) that offer certified COTA programs and they are very impacted with huge waiting lists (and a lottery system of admission). I’ve done most of my research in CA schools because that is where I am located, so maybe it is different in some other states. Do you know of any public school programs that are less crowded/easier to get into?

    • Sarah Stromsdorfer, OTR/L July 6, 2020   Reply →

      Hi Amy, I personally am not sure about how many applicants the other COTA programs are getting so I would recommend calling the programs’ admissions to ask them directly so you can get the most up to date info. Here is a list of all accredited OTA programs in the U.S.: OTA Associate Degree Programs (AOTA)

  • Regine January 8, 2021   Reply →

    Hi, I am currently taking prerequisites to get into the cota program. I am not sure how I came about the program I think I was researching online about different careers and the cota program got my attention. I’m not sure if this is for me but I do like helping people and want to be in a career that is fulfilling. Do you have any advice about how I can really prepare myself ? Right now with covid it’s a little hard being able to go and observe OTA’s

    • Sarah Stromsdorfer, OTR/L January 12, 2021   Reply →

      Hi Regine, the main thing I would say right now is to focus on your GPA and pre-req GPA. Once more facilities open up to observation hours and when you feel safe doing so, work to get as many hours as you can (over the required amount) so you will be a competitive applicant. It will also be helpful for you to see multiple COTA settings and see if the career path is right for you. Good luck!

  • Cris Warner February 24, 2021   Reply →

    Hi Sarah, This was a great article and help to understand the efforts needed to be a COTA. I appreciate you and your time to publish this. I have a question, my daughter is attending a University that will fulfill her pre-requisites for OT Masters program and earn a Bachelors in Kinesiology. What would she need to do to obtain her COTA after her Bachelors while attending her Masters program ?

    • Sarah Stromsdorfer, OTR/L February 25, 2021   Reply →

      Hi Cris, a COTA is a Certified Occupational Therapy Assistant, which is a completely different program/career path from a Master’s and Doctorate OTR program, so your daughter doesn’t need to do anything related to being a COTA 🙂

  • emely Taveras March 26, 2021   Reply →

    Hi, I am currently getting my associate’s in applied science but my only problem is, I am just now realizing that I want to become a COTA. I haven’t taken any courses for it but am in my last year of associates and feel I have wasted time taking courses for psychology. I still want to become a cota but am graduating in May. Could I go to an accredited program still if I already get my associate’s? Would I have to attend another two-year college? thanks

    • Sarah Stromsdorfer, OTR/L March 31, 2021   Reply →

      Hi Emely, if you’re interested in becoming a COTA you will still have to do an entire COTA Associate’s program even though you’re almost done with your other Associate’s. I hope this helps!

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