1 University of Northern Iowa

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University of Northern Iowa
SCHOOL OF HEALTH, PHYSICAL EDUCATION & LEISURE SERVICES
APPLICATION FOR GRADUATE ASSISTANTSHIP (2016-2017)
DUE DATE: Tuesday, March 1, 2016
Submit to: Machelle Stickler ([email protected])
Date ___________________
Year/Semester Requesting Assistantship
1. Name (in full)
Social Security #
Present Address
Permanent Address
Telephone
Email:
2. Intended Major and Area of Emphasis:
____ Master of Arts in Health Education
Emphasis Areas:
___ Health Promotion/Fitness Management
___ Community Health Education
___ School Health Education
____ Master in Kinesiology
Emphasis Areas:
___ Exercise Science
___ Sport Psychology
____ Master of Arts in Leisure Services
Emphasis Areas:
___ Leisure Services Program Management
___ Youth/Human Service Agency Administration
____ Master of Science in Athletic Training
4. Educational Background
College or University:
__________________________
Dates:
19__ to __
Major:
________
Degree:
______
Year Awarded:
_______
__________________________
19__ to __
________
______
_______
__________________________
19__ to __
________
______
_______
5. Professional Certification and/or Licensure: (Please identify)
___ Teaching
___First Aid
___Registered Nurse
___Coaching
___CPR
___Registered Dietitian
___NATA
___ACLS
___Licensed Practical Nurse
___WSI
___ACSM
___Dental Hygienist
Other__________________________________________________________
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If you hold a teaching certificate, list name or certificate and the state in which it was issued:
6. Honors and Activities: List any scholastic or professional honors, including membership in honor. List important
extracurricular activities in which you have participated and which you think will enable your ability to make a
contribution to the Schools of HPELS.
7. Professional Work Experience in Health, Physical Education and/or Leisure Services
(List subjects/activities taught in teaching/coaching area/or any teaching experiences).
Employing Institution or Agency:
Dates:
Position/Responsibilities:
___________________________
____to ____
_______________________________________
___________________________
____ to ____
_______________________________________
___________________________
____ to ____
_______________________________________
___________________________
____ to ____
_______________________________________
___________________________
____ to ____
_______________________________________
8. With which University of Northern Iowa faculty members, if any, are you well acquainted?
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9. Graduate Assistant Work Areas of Interest (If you have more than one interest, please rank these work areas).
___Biomechanics Research Assistant
___Athletic Training Research Assistant
___Exercise Science Lab Assistant
___Dimensions of Wellbeing Teaching Assistant
___Health Research Assistant
___Special Events Programming
___Motor Learning Research Assistant
___Sport Psychology Research Assistant
___Wellness Promotion Program Assistant
___Nonprofit Leadership Alliance Program Assistant
___Recreation/Leisure Lab Assistant
___Other (ex: statistics, technology)
Briefly describe any research experiences you may have had in the past, including research advisor and the project on
which you worked.
Briefly explain and special interests and/or expertise you think you would bring to the responsibilities in which you have
indicated interest:
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Dimensions of Wellbeing offers both lecture and physical activity lab components for undergraduate students. The
course will be a part of the Liberal Arts Core with approximately 1000 students per semester. A graduate teaching
assistantship in the School of HPELS involves teaching responsibilities within Dimensions of Wellbeing. As a TA, you
would be responsible for co-teaching and independently teaching physical activity lab courses. If you are interested in
receiving a Teaching Assistantship with Dimensions of Wellbeing, please indicate which activities that you have
competence and interest in teaching.
10. Teaching Areas: Using the scales given below, please rank the activities in regard to competence to teach and
interest level:
Competence:
Interest:
4 = High Competence (could teach, supervise,
or possess high skill level)
3 = High Interest
3 = Satisfactory Competency (could assist,
2 = Moderate Interest
could teach some)
1 = No Interest
2 = Moderate Interest
1 = No Competence
ACTIVITY
AQUATIC ACTIVITIES:
4
COMPETENCE
3
2
1
3
INTEREST
2
1
Scuba/Snorkeling
___
___
___
___
___
___
___
Swimming & Conditioning
___
___
___
___
___
___
___
Swimming
___
___
___
___
___
___
___
Ballet
___
___
___
___
___
___
___
Ballroom Dance
___
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___
___
___
___
Folk Dance
___
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___
___
___
Jazz Dance
___
___
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___
___
___
___
Swing
___
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___
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___
___
Barre
___
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___
Aerobic Activities
___
___
___
___
___
___
___
Zumba
___
___
___
___
___
___
___
Circuit Training
___
___
___
___
___
___
___
Kick Boxing
___
___
___
___
___
___
___
Personal Conditioning
___
___
___
___
___
___
___
Badminton
___
___
___
___
___
___
___
Bicycling
___
___
___
___
___
___
___
Fencing
___
___
___
___
___
___
___
DANCE ACTIVITIES:
Modern Dance
FITNESS ACTIVITIES:
SPORTS & LEISURE ACTIVITIES:
5
ACTIVITY
4
COMPETENCE
3
2
1
3
INTEREST
2
1
Golf
___
___
___
___
___
___
___
Judo
___
___
___
___
___
___
___
Karate
___
___
___
___
___
___
___
Other Martial Arts
___
___
___
___
___
___
___
Racquetball
___
___
___
___
___
___
___
Self Defense
___
___
___
___
___
___
___
Tennis
___
___
___
___
___
___
___
Volleyball
___
___
___
___
___
___
___
Weight Lifting
___
___
___
___
___
___
___
Nia
___
___
___
___
___
___
___
Tabata (HIIT)
___
___
___
___
___
___
___
Capoeira
___
___
___
___
___
___
___
TRX
___
___
___
___
___
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___
Pilates
___
___
___
___
___
___
___
Yoga
___
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___
___
___
___
___
Rock Climbing
___
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Backpacking
___
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Canoeing
___
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Cross Country Skiing
___
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Orienteering
___
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___
___
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Bouldering
___
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___
___
___
___
Adventure Leadership
___
___
___
___
___
___
___
Stress Mgmt: Animal Therapy
___
___
___
___
___
___
___
Stress Mgmt: Relaxation
___
___
___
___
___
___
___
Stress Mgmt: Horticulture
___
___
___
___
___
___
___
Stress Mgmt: Natural Setting
___
___
___
___
___
___
___
Injury Recovery: Happy Healing
___
___
___
___
___
___
___
OUTDOOR ACTIVITIES:
OTHER ACTIVITIES:
6
Are there any other wellness or physical activities that you have an area of expertise or experience in? Other areas that
you would feel competent teaching?
11. What are your future professional goals and how do you see graduate work contributing to accomplishing your
goals? (Attach another sheet if necessary.)
Feel free to attach a personal data sheet (resume/vita) which will provide additional information on background and
ability.
Applications are due Tuesday, March 1, 2016. Send all applications to:
Machelle Stickler, Secretary of Graduate Studies
003 HPC
University of Northern Iowa
Cedar Falls, IA 50614-0244
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