University of Northern Iowa
SCHOOL OF HEALTH, PHYSICAL EDUCATION & LEISURE SERVICES
APPLICATION FOR GRADUATE ASSISTANTSHIP (2015-2016)
DUE DATE: Friday, March 13, 2015 (Friday before Spring Break)
Submit to: Julee Jacobson (julee.jacobson@uni.edu)
Date ___________________ Year/Semester Requesting Assistantship
1. Name (in full)
Present Address
Permanent Address
Telephone
2. Intended Major and Area of Emphasis:
____ Master of Arts in Health Education
Emphasis Areas:
___ Health Promotion/Fitness Management
Email:
Social Security #
___ 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: Major: Degree:
__________________________ 19__ to __ ________ ______
Year Awarded:
_______
__________________________ 19__ to __ ________ ______ _______
__________________________ 19__ to __ ________ ______ _______
5. Professional Certification and/or Licensure: (Please identify)
___ Teaching
___Coaching
___NATA
___WSI
___First Aid
___CPR
___ACLS
___ACSM
___Registered Nurse
___Registered Dietitian
___Licensed Practical Nurse
___Dental Hygienist
Other__________________________________________________________
1

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:
___________________________ ____to ____
Position/Responsibilities:
_______________________________________
___________________________ ____ to ____ _______________________________________
___________________________ ____ to ____ _______________________________________
___________________________ ____ to ____ _______________________________________
___________________________ ____ to ____ _______________________________________
8. With which University of Northern Iowa faculty members, if any, are you well acquainted?
2

9. Graduate Assistant Work Areas of Interest (If you have more than one interest, please rank these work areas).
___Biomechanics Research Assistant
___Exercise Science Lab Assistant
___Health Research Assistant
___Motor Learning Research Assistant
___Wellness Promotion Program Assistant
___Recreation/Leisure Lab Assistant
___Athletic Training Research Assistant
___Dimensions of Wellbeing Teaching Assistant
___Special Events Programming
___Sport Psychology Research Assistant
___Nonprofit Leadership Alliance Program 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:
3

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:
4 = High Competence (could teach, supervise, or possess high skill level)
3 = Satisfactory Competency (could assist, could teach some)
2 = Moderate Interest
1 = No Competence
ACTIVITY
AQUATIC ACTIVITIES:
COMPETENCE
4 3 2 1
Interest:
3 = High Interest
2 = Moderate Interest
1 = No Interest
INTEREST
3 2 1
4
Scuba/Snorkeling
Swimming & Conditioning
___ ___ ___ ___ ___ ___ ___
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___ ___ ___ ___ ___ ___ ___ Swimming
DANCE ACTIVITIES:
Ballet
Ballroom Dance
Folk Dance
Jazz Dance
Modern Dance
Swing
Barre
___ ___ ___ ___ ___ ___ ___
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FITNESS ACTIVITIES:
Aerobic Activities
Zumba
Circuit Training
Kick Boxing
Personal Conditioning
SPORTS & LEISURE ACTIVITIES:
Badminton
Bicycling
Fencing
___ ___ ___ ___ ___ ___ ___
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ACTIVITY
Golf
Judo
Karate
Other Martial Arts
Racquetball
Self Defense
Tennis
Volleyball
Weight Lifting
Nia
Tabata (HIIT)
Capoeira
TRX
Pilates
Yoga
OUTDOOR ACTIVITIES:
Rock Climbing
Backpacking
Canoeing
Cross Country Skiing
Orienteering
Bouldering
Adventure Leadership
4
COMPETENCE
3 2 1
INTEREST
3 2 1
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OTHER ACTIVITIES:
Stress Mgmt: Animal Therapy ___ ___ ___ ___ ___ ___ ___
Stress Mgmt: Relaxation ___ ___ ___ ___ ___ ___ ___
Stress Mgmt: Horticulture
Stress Mgmt: Natural Setting
___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___
Injury Recovery: Happy Healing ___ ___ ___ ___ ___ ___ ___
5

Are there any other wellness or physical activities that you have an area of expertise or experience in? Other areas that
6 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 Friday, March 13, 2015. Send all applications to:
Julee Jabson, Secretary of Graduate Studies
203 WRC
University of Northern Iowa
Cedar Falls, IA 50614-0241