Lake Zurich High School PE Leader Program 2015-2016
Application Form
Dear Prospective Applicant:
Thank you for your interest in the PE Leader Program. This program is a two-year
course designed to provide students with opportunities for leadership development
within a physical education environment.
The Physical Education Leader Program is designed as a two-step process: one
year of instruction and acquisition of knowledge, followed by one year of leader
internship. During the first year of training, juniors gather knowledge, theory, and
application strategies used in a physical education setting. During the year of
leader internship, while assisting the physical education teacher, seniors will
demonstrate application through peer teaching, role modeling, and co-facilitating.
Part I of the application process is the Google Information Form. A link to the
form will be provided at the mandatory informational meeting on Wednesday,
February 3rd at 7:30 am in S104. After the February 3rd meeting, applicants can
find the link to the form on Ms. Levin’s PE Leader Information Page on her
website. Part II of the application form should be stapled together including the
current photo, course information sheet, and typed answers to the application
questions. Part II is due in the PE office no later than February 19th at 3:20 pm.
Part III of the application process is the tryout. The tryout process will take place
after all applications have been accepted. Notification on whether you have made
it through to the tryout stage will occur through school email approximately on or
before Monday, February 22nd. The tryout dates for this year are February 23rd,
24th and 25th from 7:00 am to 7:45 am in the Main gym. Tryout date attendance
is mandatory and any applicant missing two or more of the tryout dates will
not be considered into the program. Check your school email address
frequently for updated information. Along with the application, you will need to
hand out four PE Leader Recommendation Forms; one must go to a PE teacher
you have had here at LZHS and three may go to any teacher, sponsor or coach of
choice. The recommending teacher/sponsor/coach will be responsible for
returning completed recommendation forms to my mailbox. You will not see the
completed recommendation forms. Please make sure to fill out the top portion
(name, ID, and teacher) on each recommendation form you hand out.
The entire application, including all recommendations, must be turned into the PE
office by no later than Friday, February 19th at 3:20 pm. Applications must be
completed as directed, incomplete applications will not be accepted or considered.
If you have any questions about the program or the application requirements, you
can come see me personally, or contact me by email at michelle.levin@lz95.org.
Ms. Levin
Physical Education Teacher
PE Leader Program Coordinator
Lake Zurich High School PE Leader Program
Application Form
* Included with PART II of the application should be the following two items: a current
photo of yourself and your counselor’s signature verifying all grade and academic
standings listed below.
* All applicants must be aware that this program is a two-year commitment and no
exemptions, waivers, or early graduation requests will be allowed at any time for the full
th
duration of the program. The P.E. Leader class is scheduled for 7 hour.
Please double check your junior year class schedule to make sure you
can participate.
PART I: Please write N/A next to any information below that does not apply to you.
Name: ______________________________ ID # ____________________
Counselor: _____________________
Cumulative G.P.A _______________
Counselor’s Signature (verifying grade and G.P.A) _________________________
Freshmen 1st Semester Physical Education Teacher _________________ Grade _______
Freshmen 2nd Semester Physical Education Teacher ________________ Grade _______
Did you waive out of 1st QTR physical education for marching band? YES
NO
N/A
Sophomore 1st Semester Physical Education Teacher ________________ Grade _______
Class type (Lifetime, Individual, Weight Training etc.) _______________________
Sophomore 1st Semester Health Teacher ____________________ Grade ____________
Sophomore 1st Semester Driver Education Teacher(s) ___________________ Grade ___
Which PE class did you register for your 2nd semester sophomore year? (Lifetime Sports,
Personal Fitness, etc.) Class______________ Teacher _____________ Hour _____
List all extra/co-curricular activities in which you have been, or currently involved in at
LZHS.
Activity
Sponsor/Coach
# of Years
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Lake Zurich High School PE Leader Program
Application Form
PART II: Short Essay
Please type your answers to the following questions and ATTACH your
typed answers to the application form. Remember when answering these
questions that the more thorough and well thought out your answers, the
easier it will be to get an accurate and honest depiction of your leadership
potential. Many times candidates are NOT chosen due to the lack of
reflection in their short essay responses.
1. Why do you desire to become a physical education leader? What
specific skills and character traits do you possess that make you a
quality candidate? In your description, please provide personal action
examples as evidence of HOW you displayed these traits in your life.
2. Describe and give specific examples of activities that you have been
involved in (either in or out of school) that allowed you to exhibit
leadership traits? Have you ever had leadership experience working
with large or small groups? (e.g. camp counselor, peer mentor, captain
of a sport team, etc.). What were your specific responsibilities?
3. What is your personal philosophy on living a healthy lifestyle? How
important is eating healthy and being physically active to you?
Included in your answer should be your personal thoughts on the role
physical education class should play in a student’s life.
4. Quality school education programs should change and evolve with the
times. If you had the power to change Lake Zurich’s current physical
education curriculum, what would you change and why? Please be
open and honest with your answers. Please note that changing
‘nothing’ is not an adequate answer.
5. What expectations would you place on yourself if chosen to be a part
of this two-year leaders program? After meeting those expectations
over time, what do you hope the program will give you in return?
6. Describe ONE of the following: A significant experience,
achievement, risk you have taken, or ethical dilemma you have faced
and its impact on you.
Lake Zurich High School PE Leader Program
Recommendation Form
Congratulations! You have been honorably selected to fill out a student
recommendation form for admittance into the PE Leader Program.
The physical education department is currently taking applications for
prospective sophomore candidates that aspire to be a part of the two-year
junior/senior leader program in physical education.
The leader program is designed to teach and implement Strategic Core Values and
Objectives as a means to promote positive student achievement. Through a
comprehensive curriculum of team building and cooperative based learning strategies,
students will have an opportunity to explore leadership roles, build positive, respectful
relationships with peers and teachers and exemplify characteristics of an outstanding
citizen. By demonstrating skills, leading large and small groups in activity and acquiring
knowledge related to the field of physical education, students will cultivate an interest in
leader based professions. The overall goal of the PE Leader Program is to provide
opportunities for leadership development in our students within a physical
education environment.
The method of application and selection into the program requires that each
candidate be evaluated by a teacher/sponsor. The comments and input you
provide will help insure that the top students with leadership potential get
selected to be a part of the program.
Please take the time to fill out the evaluation on the reverse side. All
recommendation forms are confidential and will not be seen by the
applicant. Any additional comments you would like to make that might
provide insight into the leadership potential of this candidate would be
greatly appreciated.
* Completed recommendation forms are to be returned to my mailbox by no
later than Friday, February 19th 2016.
Thanks for giving up some of your valuable time to benefit the physical
education department. If you have any questions concerning this form,
please don’t hesitate to contact me at ext. 5463 or email me at
michelle.levin@lz95.org.
Sincerely,
Michelle Levin
PE Leader Program Coordinator
** Please return this form to Ms. Levin’s mailbox by Friday, February 19th
Lake Zurich High School PE Leader Program Recommendation Form
Name of Applicant: _______________________ ID# ____________________
Recommending Teacher/Sponsor/Coach: _________________ Signature: ____________
Use the following descriptions to rate the prospective applicant:
1. Academic Work Ethic – Displays a high level of effort and accountability; strives to improve.
2. Assertiveness – Self-confident and self assured; steps up and takes initiative when directing others.
3. Communication Skills – Proficient public speaker; speaks with purpose and strength of voice.
4. Integrity – Honest and trustworthy; displays a high level of respect for school and self.
5. Consideration for Others – Empathetic and patient; enjoys helping others and providing service.
6. Problem Solving Skills – Able to think quickly on one’s feet; adapts creatively to adversity.
7. Time Management – Multitasks and takes risks; tackles multiple activities with confidence.
8. Relationship with Adults – Communicates respectfully and honestly; follows directions.
9. Relationship with Peers – Well respected and admired by peers; leads by example.
10. Teachability - Able and willing to learn in diverse environments; responds well to criticism.
Rank the students in the following categories with 1 being the lowest and 4 being the
highest. A score of 4 is extremely difficult to receive. Consider giving a 4 only when
this student demonstrates unwavering commitment to the behavior trait.
LOW
HIGH
(Very little) (Sometimes)
(Almost always)
(Without fail)
Academic Work Ethic
1
2
3
4
Assertiveness
1
2
3
4
Communication Skills
1
2
3
4
Integrity
1
2
3
4
Consideration for Others
1
2
3
4
Problem Solving Skills
1
2
3
4
Time Management
1
2
3
4
Relationship with Adults
1
2
3
4
Relationship with Peers
1
2
3
4
Teachability
1
2
3
4
Comments on overall leadership potential: _____________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________