Photo of a group of wheelchair users in the park.

A TRS may obtain a degree in Therapeutic Recreation or Recreation with an option in TR. Currently, universities offering four-year degree programs in TR can be found in 40 U.S. states. Degree requirements include a 360-hour internship under the supervision of a certified TRS. Courses taken outside of the major usually include but are not limited to: anatomy and physiology; psychology; and medical terminology.

Once degree requirements are completed, the TRS may opt to sit for a national certification exam. The National Council for Therapeutic Recreation Certification (NCTRC Link) requires an application process to determine if the candidate has met certain requirements such as specified coursework and an internship and acquired specific skills during the internship. The 200-question exam is offered two or three times per year in various locations. Once the applicant has passed the exam, he or she is given the title of Certified Therapeutic Recreation Specialist (CTRS). A CTRS has the authority to treat any patient, including those requested by doctor's orders.