Sport and Exercise Science Undergraduate Practicum Application Packet Instructions

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Sport and Exercise Science Undergraduate Practicum Application Packet Instructions"

Transcription

1 Sport and Exercise Science Undergraduate Practicum Application Packet Instructions Please read the ENTIRE instructions and information sheets carefully for complete directions and information before completing application packet! Make sure that your application is complete, legible, and neatly presented. Your application is a reflection of you now, and as a future professional. PLEASE DO NOT PRINT PAGES DOUBLE SIDED TO BE ELIGIBLE FOR PRACTICUM, STUDENTS MUST: Have minimum 2.75 overall GPA Have successfully completed, or be enrolled in all required courses Complete practicum in their final term. Be approved by their advisor as well as the Sport and Exercise Science program coordinator. Complete a formal application for Practicum by the deadline. All requirements must be satisfied by the time grades are posted the semester prior to your practicum experience. NOTICE: Students should be aware: If you have been arrested for certain crimes, you MAY NOT be qualified for practicum and MAY NOT be able to be hired as a Sport and Exercise professional. (See Disclosure Form ) BEFORE YOU BEGIN SECURING A PRACTICUM SITE: Discuss your practicum placement with your advisor. The practicum experience is designed to be a valuable learning opportunity. The site you choose should be meaningful and make sense for what you would like to do when you graduate. Verify with your advisor in advance that your practicum site would be approved for you. You can also ask your advisor for a list of sites where students have completed practicum in the past. ONCE YOU HAVE CHOSEN A PRACTICUM SITE: Complete your practicum packet and obtain the approval and signature of the practicum site supervisor. Then, schedule an appointment early to meet with your advisor, as his/her office hours may not fit easily into your schedule. It is your responsibility to obtain your advisor s signature on your practicum application, and to submit it well in advance of the end of the term prior to your graduation. Remember that you cannot be approved to take Capstone, PET 4901 until you are enrolled in all classes for your final term, INCLUDING practicum.

2 Instructions continued: A Complete Application Packet should be in this order and include ALL of the following documents: Incomplete packets will not be approved. Remember, this is a professional submission and is a reflection of you. 1. Application/Placement sheet 2. Disclosure Sheet 3. Statement of Responsibility 4. Cover Letter (One page only) 5. Resume Note: Practicum Supervisor Evaluation and Placement Hours Authorization should not be submitted with the packet, but are instead due at the end of the practicum. The instruction pages should also not be submitted with the practicum application. WHAT IS EXPECTED OF YOU DURING YOUR PRACTICUM EXPERIENCE: The practicum site you have chosen should be a great learning experience for you. The Sport and Exercise Science program is very grateful that these individuals/businesses are willing to offer our students this opportunity. Students are representing themselves, as well as UCF and are expected to behave in a professional manner that reflects the high caliber of our students. Each practicum experience will be different depending on the needs at the site, as well as your qualifications and strengths. Be open to learning and willing to give 110%. All students are required to complete 360 contact hours at their practicum site. Your particular practicum schedule will depend on the needs of your particular site, as well as your availability. The UCF Practicum Supervisor will be meeting with you and your site supervisor at your practicum site to check on your progress. Students must provide the UCF Practicum Supervisor with their practicum schedule no later than the end of the first week of classes in the practicum term. Students are expected to log into Web Courses as soon as the term begins to access the course syllabus and review the practicum requirements. All assignments must be submitted through Web Courses by the deadlines. The name of the UCF Practicum Supervisor will appear on your schedule just as an instructor s or professor s name would appear on any other class. Any questions regarding practicum should be directed to that individual. Practicum is 9 credit hours and is graded on an S or U basis. All practicum requirements must be met in order to earn a grade of S and pass practicum. Note: We highly recommend that students become certified in First Aid and CPR before beginning their practicum. Both of these certifications are available through the Recreation and Wellness Center on campus.

3 University of Central Florida Sport and Exercise Science Practicum Application PLEASE WRITE LEGIBLY Last Name First Name PID: Knights Address: Phone Current Home Address Expected Graduation Term/Year Practicum Term/Year Track or Specialization: Career Goals: Students must have an overall GPA of 2.75 to be eligible for Practicum: Overall GPA UCF GPA Practicum Site Information Name of Site: Site Address: Site Supervisor: Position: Site Supervisor s Phone Site Supervisor s signature: Date: (Practicum contact hours 360)

4 Please carefully read and initial each statement below: Student Responsibilities By signing this application, I agree to accept the placement, and provide my own transportation. I understand that I am responsible to forward my entire application, including the Disclosure Sheet to the practicum site before the practicum begins. If I responded YES on the Disclosure Sheet, I understand that I must attach an from my site supervisor, acknowledging that they are aware of all of the information included in the Disclosure of Background Information. I further understand that the application cannot be approved until that is provided. I am responsible to pay any fees or provide any documentation required for background checks. I understand that I must submit my practicum schedule to the UCF Practicum supervisor by the end of the first week of class. If my schedule changes or if I am unable to complete my assigned hours on any given day, I must notify the Site Supervisor as well as the UCF Practicum Supervisor in advance. I have read and agree to abide by the Policies and Procedures set by the participating business partner. I understand that it is my responsibility to abide by the guidelines and procedures of the Sport and Exercise program. I understand that I will be enrolled in PET 4926, Practicum for 9 credit hours. It is MY responsibility to check my schedule before the end of add/drop to make sure that it is correct. Lastly, I understand that this practicum packet is a reflection of me and should be presented professionally. I have read all the instructions and have double-checked my application packet to make sure that it meets the requirements as listed in the instructions. I also understand that incomplete practicum packets and applications will not be approved. Student s signature: Date: Advisor s signature: Date: Departmental Approval: Date: Reproduce a copy of this application for your records.

5 University of Central Florida Disclosure Sheet Sport and Exercise Science Name: Last First Middle Disclosure of Background Information I understand that I am subject to the rules/regulations of the business in which I am placed. I am aware that the business has the right to do a personal background check. Have you ever (as a juvenile or an adult) at any time been arrested and/or convicted, pled nolo contender (no contest), had a record sealed or expunged, been placed on probation, enrolled in a pre-trial diversion program, or had adjudication withheld in a criminal offense, felony, misdemeanor or otherwise, and/or are there any criminal charges now pending against you other than a non-criminal traffic violation? YES NO If you responded YES to the question above, please attach: 1. A handwritten statement outlining the offense, the court s decision, and your compliance with the judgment. 2. A copy of the arrest record. 3. A copy of any court records. 4. A copy of probation release, if applicable. 5. A copy of fines paid, if applicable. Be advised: If you have been arrested for certain crimes, you MAY NOT be qualified for practicum and MAY NOT be able to be hired as a Sport and Exercise professional. (See Disclosure Form ) I understand that this form, along with supporting documentation, will be submitted to the practicum site supervisor for review and final approval. I further understand that if I responded YES to the question above, I must provide an from the site supervisor acknowledging that they have read and were aware of the information included with the Disclosure of Background Information, before approving your practicum application. Student s Signature Date

6 University of Central Florida Statement of Responsibility Student s Name: Student PID: Student Knights Student Phone Number: I understand that I will be enrolled in PET 4926 Practicum for 9 credit hours. I accept responsibility for payment of my semester tuition and fees by the published deadline. I understand that if I fail to pay my tuition and fees by the deadline, I will be charged a $100 Late Payment Fee, my records may be put on hold, my courses may be dropped, my account may be referred to a collection agency, and I may incur other financial consequences. If for any reason I decide not to complete practicum it is MY responsibility to drop it by the drop deadline as published in the UCF Academic Calendar. Student s Signature Date

7 UCF Sport and Exercise Science Practicum Supervisor Evaluation We would appreciate your answers to the following questions to help us evaluate the Practicum student and his/her performance and to improve the undergraduate Sport and Exercise Science program at UCF. UCF Sport and Exercise Science Student Name: Supervisor Name: Practicum Placement Location: Based on the scale below, in your observation, to what extent do you agree or disagree that the UCF Sport and Exercise Science Practicum student you supervised displayed the following professional characteristics? (SA) Strongly Agree (A) Agree (N) Neutral (D) Disagree (SD) Strongly Disagree 1. Punctuality 2. Reliability 3. Professional Image, Dress, and Appearance 4. Maturity 5. Oral Communication and Presentation Skills 6. Written Communication 7. Group work and Teambuilding Skills 8. Leadership 9. Strong Interpersonal Skills 10. Continuous Improvement 11. Critical Thinking 12. Working with Diverse Populations 13. Professional Ethics 14. Professional Knowledge and Skills 15. Understanding of Human Development and Performance (if appropriate) 16. Use of Fitness and Presentation Technology (if appropriate)

8 17. To what extent do you agree or disagree that the Sport and Exercise Science Practicum student you supervised is prepared to become an industry professional? (SA) Strongly Agree (A) Agree (N) Neutral (D) Disagree (SD) Strongly Disagree 18. To what extent do you agree or disagree that the Sport and Exercise Science Practicum student you supervised is prepared to sit for their industry certification exams? (SA) Strongly agree (A) Agree (N) Neutral (D) Disagree (SD) strongly disagree Please write your response to the following questions in the space available. 19. In what way did the Sport and Exercise Science Practicum student you supervised best meet your expectations? 20. What change(s) might you suggest to improve the Sport and Exercise Science Practicum Placement program? 21. Would you consider accepting another UCF Sport and Exercise Science undergraduate student for a future: Practicum Placement (360 hours)? If no, please explain briefly. Practicum Site Supervisor: Please seal this form in an envelope with your signature across the fold, and return to the student to provide to their Practicum Supervisor at UCF. THANK YOU FOR YOUR INPUT AND THE OPPORTUNITY FOR OUR STUDENTS!

9 UCF Sport and Exercise Science Practicum Hours Log Student Name: PID: Knights Term/Year: Practicum Placement Location: Supervisor Name: (Printed) Title: Phone Minimum total of 360 contact hours is required during Practicum. DATE # Hours DATE # Hours TOTAL HOURS: Practicum Student Signature: Date: Practicum Site Supervisor Signature: Date:

Peer Mentor Program Application

Peer Mentor Program Application University of South Florida Peer Mentor Program Application College of Arts and Sciences 2/3/2016 WELCOME LETTER Thank you for your interest in becoming a USF College of Arts and Sciences Peer Mentor.

More information

University of Rhode Island Counseling Center 217 Eleanor Roosevelt Hall Kingston, Rhode Island TEL: FAX:

University of Rhode Island Counseling Center 217 Eleanor Roosevelt Hall Kingston, Rhode Island TEL: FAX: University of Rhode Island Counseling Center 217 Eleanor Roosevelt Hall Kingston, Rhode Island 02881 TEL: 401-874-2288 FAX: 401-874-5010 Clinical Graduate Application Process: Note. This application is

More information

RPSGT Exam Application For New Candidates CERTIFICATE EXAMINATION FOR POLYSOMNOGRAPHIC TECHNICIANS BOARD OF REGISTERED POLYSOMNOGRAPHIC TECHNOLOGISTS

RPSGT Exam Application For New Candidates CERTIFICATE EXAMINATION FOR POLYSOMNOGRAPHIC TECHNICIANS BOARD OF REGISTERED POLYSOMNOGRAPHIC TECHNOLOGISTS CERTIFICATE EXAMINATION FOR POLYSOMNOGRAPHIC TECHNICIANS RPSGT Exam Application For New Candidates BRPT Application Processing Dept. 8400 Westpark Dr Second Floor McLean, VA 22102 Fax: 703-610-0229 www.brpt.org

More information

Note: Transcripts must be official, which means they must be sent from the schools directly to Admissions; they cannot be delivered by students.

Note: Transcripts must be official, which means they must be sent from the schools directly to Admissions; they cannot be delivered by students. Jefferson College Physical Therapist Assistant Program Admission Checklist 2014 Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Complete an application to Jefferson College. There is a $25 non-refundable application

More information

Application Instructions for:

Application Instructions for: Regular Mailing Address Courier Delivery Address Application Instructions for: MASSAGE THERAPIST LICENSURE FOR EXISTING PRACTITIONERS USE THIS APPLICATION ONLY IF YOU WERE AN EXITISTING PRACTITIONER ON

More information

Dear Prospective Degree Completion Dental Hygiene Student:

Dear Prospective Degree Completion Dental Hygiene Student: Dear Prospective Degree Completion Dental Hygiene Student: Thank you for your interest in the Dental Hygiene Program at Southern Illinois University Carbondale. SIUC s Dental Hygiene Program is nationally

More information

Centennial Middle School Chapter of the National Junior Honor Society Student Activity Information Form (NOT AN APPLICATION FORM)

Centennial Middle School Chapter of the National Junior Honor Society Student Activity Information Form (NOT AN APPLICATION FORM) Centennial Middle School Chapter of the National Junior Honor Society Student Activity Information Form (NOT AN APPLICATION FORM) RETURN TO MRS. NORTHRUP IN THE FRONT OFFICE BY 3:30, AUGUST 14, 2017 Directions:

More information

PLEASE MAIL APPLICATION AND ORIGINAL TRANSCRIPTS TO: Lamar Institute of Technology

PLEASE MAIL APPLICATION AND ORIGINAL TRANSCRIPTS TO: Lamar Institute of Technology Lamar Institute of Technology Allied Health Department Dear Applicant: Thank you for considering LIT s Diagnostic Medical Sonography Program for your education and career. Attached please find all necessary

More information

National Association of Forensic Counselors

National Association of Forensic Counselors NAFC MEMBERSHIP APPLICATION FOR FORENSIC SPECIALTIES Thank you for your interest in NAFC Membership. If you have any questions pertaining to this application, please contact us and we will assist you to

More information

DENTAL HYGIENE LICENSURE BY CREDENTIALS

DENTAL HYGIENE LICENSURE BY CREDENTIALS LOUISIANA STATE BOARD OF DENTISTRY 365 CANAL PLACE, SUITE 2680 NEW ORLEANS, LOUISIANA 70130 PHONE: 504-568-8574 ~ FAX: 504-568-8598 www.lsbd.org DENTAL HYGIENE LICENSURE BY CREDENTIALS Applying for a license

More information

SOCIAL WORK PROGRAM. Field Practicum Application. City: State: Zip:

SOCIAL WORK PROGRAM. Field Practicum Application. City: State: Zip: SOCIAL WORK PROGRAM Field Practicum Application Name: Date: Address: Home Phone: E-Mail Work Phone: K#: Local Street Address or Box #: City: State: Zip: DOB: Marital Status: Driver s License Number and

More information

APPLICATION FOR ADMISSION to the DIAGNOSTIC MEDICAL SONOGRAPHY PROGRAM SUMMER 2018 ENTRY

APPLICATION FOR ADMISSION to the DIAGNOSTIC MEDICAL SONOGRAPHY PROGRAM SUMMER 2018 ENTRY APPLICATION FOR ADMISSION to the DIAGNOSTIC MEDICAL SONOGRAPHY PROGRAM SUMMER 2018 ENTRY LAKE MICHIGAN COLLEGE ASSOCIATE IN APPLIED SCIENCE DIAGNOSTIC MEDICAL SONOGRAPHY NAME LMC STUDENT ID NUMBER ADDRESS

More information

Associate of Applied Science Degree Physical Therapist Assistant Application Fall 2018

Associate of Applied Science Degree Physical Therapist Assistant Application Fall 2018 Moving Mountains Building Communities Physical Therapist Assistant Application Fall 2018 Open date: July 2017 Applicants can begin submitting program applications. Close date: Friday, March 30, 2018, 5PM

More information

2017 BEING RU-FIT (First Year International Transition) Peer Mentor Position Description

2017 BEING RU-FIT (First Year International Transition) Peer Mentor Position Description I. Overview 2017 BEING RU-FIT (First Year International Transition) Peer Mentor Position Description The Peer Mentor is a leader on campus who will help ease the transition to college for first-year international

More information

CITY OF ARCADIA MASSAGE THERAPIST APPLICATION PACKET

CITY OF ARCADIA MASSAGE THERAPIST APPLICATION PACKET CITY OF ARCADIA MASSAGE THERAPIST APPLICATION PACKET Arcadia City Hall Arcadia Police Department 240 W Huntington Dr 250 W Huntington Dr Arcadia CA 91007 Arcadia CA 91007 626-574-5430 626-574-5150 Thank

More information

DEPARTMENT OF SOCIAL WORK APPLICATION TO THE B.S.W. DEGREE PROGRAM TO BECOME A SOCIAL WORK MAJOR

DEPARTMENT OF SOCIAL WORK APPLICATION TO THE B.S.W. DEGREE PROGRAM TO BECOME A SOCIAL WORK MAJOR DEPARTMENT OF SOCIAL WORK APPLICATION TO THE B.S.W. DEGREE PROGRAM TO BECOME A SOCIAL WORK MAJOR General Information First Name Middle Name Last Name Date of Application Date of Birth Campus ID # UAM E-Mail

More information

Hello! Again, thank you so much for your interest in becoming a Kentucky Adult Peer Support Specialist! Sincerely, David Riggsby

Hello! Again, thank you so much for your interest in becoming a Kentucky Adult Peer Support Specialist! Sincerely, David Riggsby Hello! Thanks for your interest in Adult Peer Support Specialist Training! We are pleased to offer a curriculum that has been approved by the Kentucky Department for Behavioral Health, Developmental and

More information

National Association of Forensic Counselors

National Association of Forensic Counselors NAFC MEMBERSHIP APPLICATION FOR ADDICTIONS SPECIALTIES Thank you for your interest in NAFC Membership. If you have any questions pertaining to this application, please contact us and we will assist you

More information

Admission Packet Physical Therapist Assistant Program September 2017 for Class of 2020 Applicants

Admission Packet Physical Therapist Assistant Program September 2017 for Class of 2020 Applicants Dear Prospective Physical Therapist Assistant Student: Admission Packet Physical Therapist Assistant Program September 2017 for Class of 2020 Applicants Thank you for your interest in our Physical Therapist

More information

Please remember these are minimum requirements and do not guarantee acceptance into the program.

Please remember these are minimum requirements and do not guarantee acceptance into the program. Dear Prospective Dental Hygiene Student: Thank you for your interest in the Dental Hygiene Program at Carbondale. The Dental Hygiene Program is nationally recognized for both quality of faculty and graduates.

More information

North Carolina Board of Physical Therapy Examiners Application for Physical Therapist Licensure

North Carolina Board of Physical Therapy Examiners Application for Physical Therapist Licensure FOR OFFICIAL USE ONLY Name: End: Ex: Rev by End: Exost: Board Approved by: PT Endorsement Application Examination Date: / / ID Number: / / Exam Form Number: / / SCORES: Scaled: / / Raw: / / NC Passing:

More information

APPLICATION TO EMPLOY A

APPLICATION TO EMPLOY A STATE OF CALIFORNIA - STATE AND CONSUMER SERVICES AGENCY ARNOLD SCHWARZENEGGER, Governor BOARD OF PSYCHOLOGY 2005 Evergreen Street, SUITE 1400 SACRAMENTO, CA 95815-3831 (916) 263-2699 ext. 3303 www.psychboard.ca.gov

More information

Henderson Alternative Breaks

Henderson Alternative Breaks Henderson Alternative Breaks The Henderson State University s alternative break program, Spring Break 2018: March 19- March 23 Site Leader Application 2017-2018 ABOUT THE POSITION Site Leaders make alternative

More information

RADIOLOGIST ASSISTANT MASTER S PROGRAM APPLICANT PROCEDURES & CHECK LIST

RADIOLOGIST ASSISTANT MASTER S PROGRAM APPLICANT PROCEDURES & CHECK LIST RADIOLOGIST ASSISTANT MASTER S PROGRAM APPLICANT PROCEDURES & CHECK LIST APPLICATION PROCEDURES Please read the following procedures carefully. All applicants must submit the items listed in the checklist

More information

Henry Ford Hospital Diagnostic Medical Sonography Program

Henry Ford Hospital Diagnostic Medical Sonography Program Revised February 2017 Henry Ford Hospital Diagnostic Medical Sonography Program Application for Admission Do not complete this form until you have read the Admission Standards statement. Additional documentation,

More information

Dental Hygiene Program Information Session. Conway Grand Strand Georgetown

Dental Hygiene Program Information Session. Conway Grand Strand Georgetown Dental Hygiene Program Information Session Speir Dental Sciences Complex Grand Strand Campus General Information Reviewing this information session is REQUIRED for admission to the Dental Hygiene Program.

More information

PHYSICAL THERAPIST ASSISTANT PROGRAM ADMISSION INFORMATION

PHYSICAL THERAPIST ASSISTANT PROGRAM ADMISSION INFORMATION PHYSICAL THERAPIST ASSISTANT PROGRAM ADMISSION INFORMATION 2018 Cohort NOTES Updated November 2017 PTA Program Admission Information Booklet Page 2 TABLE OF CONTENTS Abbreviations... 3 Introduction...

More information

Crisis Prevention & Intervention Hotline Counselor Application

Crisis Prevention & Intervention Hotline Counselor Application Crisis Prevention & Intervention Hotline Counselor Application Date of Application Submit completed applications to: Pamela Lee, Volunteer Coordinator volunteer@every-mind.org Fax 301.738.1030 PERSONAL

More information

DENTAL HYGIENE PROGRAM INFORMATION PACKET

DENTAL HYGIENE PROGRAM INFORMATION PACKET DENTAL HYGIENE PROGRAM INFORMATION PACKET Thank you for your interest in the dental hygiene program. This information packet has been prepared to assist prospective students with the process of applying

More information

Musculoskeletal Sonography Certificate Admissions Requirements

Musculoskeletal Sonography Certificate Admissions Requirements Musculoskeletal Sonography Certificate Admissions Requirements Applicants must hold an approved credential or have graduated from an accredited sonography program or have a professional licensure to apply

More information

Dental Hygiene Program Information/Application Packet

Dental Hygiene Program Information/Application Packet Introduction: Information/Application Packet The MSSU provides basic education and experience, to prepare graduates for licensure as dental hygienists. Each fall semester a class of 30 students will begin

More information

Substantial Equivalency Process for Massage Therapists

Substantial Equivalency Process for Massage Therapists Substantial Equivalency Process for Massage Therapists May 2014 Substantial Equivalency Process Purpose of Substantial Equivalency To provide existing practitioners with an opportunity to best understand

More information

North Carolina Peer Support Specialist Training Program Application

North Carolina Peer Support Specialist Training Program Application Vaya Health North Carolina Peer Support Specialist Training Program Application What does the training require? Vaya Health s North Carolina Peer Support Specialist Training is a 40-hour program that takes

More information

Physical Therapist Assistant Applicant Fees Form

Physical Therapist Assistant Applicant Fees Form Physical Therapist Assistant Applicant Fees Form You must pay two non-refundable fees in order to apply to the Physical Therapist Assistant (PTA) Program, $50.00 application fee and $12.00 Washington State

More information

Sandra Pence, MS, RDH Professor and Program Director UAA Dental Hygiene Program Office: AHS 148D (907)

Sandra Pence, MS, RDH Professor and Program Director UAA Dental Hygiene Program Office: AHS 148D (907) P a g e 1 Sandra Pence, MS, RDH Professor and Program Director UAA Dental Hygiene Program Office: AHS 148D (907) 786-6925 pence@uaa.alaska.edu Introduction: Thank you for your interest in the UAA Dental

More information

Sonography Program Application and Information Packet. Lackawanna College Sonography Programs Technical Standards

Sonography Program Application and Information Packet. Lackawanna College Sonography Programs Technical Standards Sonography Program Application and Information Packet The ultrasound profession is subdivided into nine specialties. The specialties offered at Lackawanna College are General Diagnostic Medical Sonography,

More information

PLEASE MAIL APPLICATION AND ORIGINAL TRANSCRIPTS TO: Lamar Institute of Technology

PLEASE MAIL APPLICATION AND ORIGINAL TRANSCRIPTS TO: Lamar Institute of Technology Lamar Institute of Technology Allied Health Department Dear Applicant: Thank you for considering LIT s Diagnostic Cardiac (Echocardiography) Sonography Program for your education and career. Attached please

More information

It is the applicant s responsibility to:

It is the applicant s responsibility to: It is the applicant s responsibility to: 1. Return the completed application by February 1 to: Howard College Dental Hygiene 1001 Birdwell Lane Big Spring, TX 79720 It is strongly encouraged that you mail

More information

2018 National ASL Scholarship

2018 National ASL Scholarship Eligibility Statement 2018 National ASL Scholarship Deadline: May 11, 2018 High school seniors planning to major or minor in American Sign Language, Deaf Studies, Deaf Education, or Interpreter Preparation

More information

Arkansas Association of the Deaf High School Scholarship Program

Arkansas Association of the Deaf High School Scholarship Program Arkansas Association of the Deaf High School Scholarship Program AN INTRODUCTION AAD historically has made funds available to the Arkansas School for the Deaf to add to a pool of funds that would be awarded

More information

Musculoskeletal Sonography Application Requirements

Musculoskeletal Sonography Application Requirements Musculoskeletal Sonography Application Requirements Entry Spring 2018 MUSCULOSKELETAL SONOGRPAHY APPLICATION REQUIREMENTS Below are the general admissions requirements for all health programs followed

More information

Dear Dental Hygiene Program Applicant:

Dear Dental Hygiene Program Applicant: Dear Dental Hygiene Program Applicant: Thank you for considering the College Of New Caledonia Dental Hygiene Program in your career planning. We trust that you have thoroughly read about the Dental Hygiene

More information

Certified Peer Specialist Training

Certified Peer Specialist Training Certified Peer Specialist Training Feb 19 Mar 2, 2018 Scranton CPS Training Facilitated by RI Consulting (formerly Recovery Opportunity Center) Date & Time: Training is Feb 19 Mar 2, 2018 and runs approximately

More information

Metropolitan Community College- Penn Valley Physical Therapist Assistant Program Application

Metropolitan Community College- Penn Valley Physical Therapist Assistant Program Application Metropolitan Community College- Penn Valley Physical Therapist Assistant Program Application Accredited by: ATTENTION Beginning with the June 10 th application for both PTA programs there is a new requirement

More information

3726 E. Hampton St., Tucson, AZ Phone (520) Fax (520)

3726 E. Hampton St., Tucson, AZ Phone (520) Fax (520) 3726 E. Hampton St., Tucson, AZ 85716 Phone (520) 319-1109 Fax (520)319-7013 Exodus Community Services Inc. exists for the sole purpose of providing men and women in recovery from addiction with safe,

More information

Criteria and Application for Men

Criteria and Application for Men Criteria and Application for Men Return completed form via fax or email to LIVESTRONG Foundation attn LIVESTRONG Fertility Fax 512.309.5515 email Cancer.Navigation@LIVESTRONG.org Made possible by participating

More information

Diagnostic Medical Sonography Program Guide, Curriculum & Observation Log

Diagnostic Medical Sonography Program Guide, Curriculum & Observation Log Diagnostic Medical Sonography Program Guide, Curriculum & Observation Log The Diagnostic Medical Sonography (DMS) Program at the University of Southern Indiana provides a curriculum which includes didactic

More information

Certified Peer Specialist (CPS) Training Program Application-2017

Certified Peer Specialist (CPS) Training Program Application-2017 Certified Peer Specialist (CPS) Training Program Application-2017 Sponsored by Southwest Behavioral Health Management, Inc. Place an X beside the session you are interested in attending: (Please choose

More information

COLLEGIATE RECOVERY PROGRAM APPLICATION

COLLEGIATE RECOVERY PROGRAM APPLICATION 1/27/16 COLLEGIATE RECOVERY PROGRAM INFORMATION Applications for the CRP should be complete before the start of the semester to be considered. Applications received while a semester is in progress will

More information

University of Denver Disability Services Program: Policies and Procedures Interpreting/CART/VRI Services for Deaf and Hard of Hearing Students

University of Denver Disability Services Program: Policies and Procedures Interpreting/CART/VRI Services for Deaf and Hard of Hearing Students University of Denver Disability Services Program: Policies and Procedures Interpreting/CART/VRI Services for Deaf and Hard of Hearing Students PROSPECTIVE STUDENT RESPONSIBILTIES Students should contact

More information

Certified Peer Specialist Training Application

Certified Peer Specialist Training Application Please read the CPS Application Supplement before completing application. Go to http://www.viahope.org/resources/peer-specialist-training-application-supplement This training is intended for individuals

More information

Dental Hygiene Program Information Packet A.A.S. Degree

Dental Hygiene Program Information Packet A.A.S. Degree Dental Hygiene Program Information Packet A.A.S. Degree This Information Packet provides the prospective applicant with information about the Dental Hygiene Program admission process at Montgomery County

More information

*To reserve your place in the training, you must submit the completed application along with a minimum

*To reserve your place in the training, you must submit the completed application along with a minimum APPLICATION INSTRUCTIONS The Epídavros Teacher Training programs includes a vigorous two-hour asana practice. We strongly recommend that applicants have one year of consistent asana practice. If your yoga

More information

MC IRB Protocol No.:

MC IRB Protocol No.: APPLICATION FORM - INITIAL REVIEW INSTITUTIONAL REVIEW BOARD Room 117 Main Building 555 Broadway Dobbs Ferry NY 10522 Phone: 914-674-7814 / Fax: 914-674-7840 / mcirb@mercy.edu MC IRB Protocol No.: Date

More information

Physical Therapist Assistant Program Information Packet A.A.S. Degree

Physical Therapist Assistant Program Information Packet A.A.S. Degree Physical Therapist Assistant Program Information Packet A.A.S. Degree This Information Packet provides the prospective applicant with information about the Physical Therapist Assistant (PTA) Program admission

More information

SOUTH TEXAS COLLEGE PHYSICAL THERAPIST ASSISTANT PROGRAM FREQUENTLY ASKED QUESTIONS

SOUTH TEXAS COLLEGE PHYSICAL THERAPIST ASSISTANT PROGRAM FREQUENTLY ASKED QUESTIONS SOUTH TEXAS COLLEGE PHYSICAL THERAPIST ASSISTANT PROGRAM FREQUENTLY ASKED QUESTIONS Contents FAQs... 2 What Is A Physical Therapist Assistant?... 2 Do I Need A License To Be A PTA In Texas?... 2 What Are

More information

Application for BSW Internship and Practice Courses The School of Social Work at Bridgewater State University

Application for BSW Internship and Practice Courses The School of Social Work at Bridgewater State University Application for BSW Internship and Practice Courses The School of Social Work at Bridgewater State University Name (printed) Banner ID# (To be completed by Social Work Staff) Date Received by School of

More information

Workforce-Education/Physical-Therapist-Assistant

Workforce-Education/Physical-Therapist-Assistant PHYSICAL THERAPIST ASSISTANT PROGRAM FACT SHEET AND APPLICATION PACKET Program Website: PTA Program Email: www.odessa.edu/programs/career-technical-and- Workforce-Education/Physical-Therapist-Assistant

More information

San José State University Department of Kinesiology Fall 2015, KIN 30 Pilates

San José State University Department of Kinesiology Fall 2015, KIN 30 Pilates San José State University Department of Kinesiology Fall 2015, KIN 30 Pilates Contact Information Instructor Junko Linafelter Office Location N/A Telephone N/A Email Junko.Linafelter@sjsu.edu Office Hours

More information

Great Falls College MSU Dental Assistant Program. Student Information and Application Packet Fall 2018

Great Falls College MSU Dental Assistant Program. Student Information and Application Packet Fall 2018 Great Falls College MSU Dental Assistant Program Student Information and Application Packet Fall 2018 (Application is subject to change year to year) Updated February 14, 2018 for Fall 2018 intake Page

More information

FACILITATOR TRAINING. TO REGISTER See pages 2-7 for more information and to register

FACILITATOR TRAINING. TO REGISTER See pages 2-7 for more information and to register FACILITATOR TRAINING DATES & LOCATIONS Wednesday, September 14, 2016 Chicago, IL Wednesday, November 9, 2016 Springfield, IL Wednesday, November 16, 2016 Chicago, IL* Wednesday, March 15, 2017 Chicago,

More information

Peer-to-Peer 2018 Teacher Training Application & Agreement

Peer-to-Peer 2018 Teacher Training Application & Agreement Peer-to-Peer 2018 Teacher Training Application & Agreement TRAINING LOCATION: KIRKLAND 3-DAY TRAINING SCHEDULE APPLICATION DEADLINE Friday, September 7, 2018 9:00 am 6:00 pm Friday, August 24, 2018 Saturday,

More information

Introduction. Click here to access the following documents: 1. Application Supplement 2. Application Preview 3. Experiential Component

Introduction. Click here to access the following documents: 1. Application Supplement 2. Application Preview 3. Experiential Component Introduction The Via Hope Recovery Institute aims to promote mental health system transformation by helping organizations develop practices that support and expect recovery, and by promoting the voices

More information

2016 Standards of Excellence Application Guidelines Presented by Fraternity & Sorority Life Wednesday, January 27, 2016 at 11:59 p.m.

2016 Standards of Excellence Application Guidelines Presented by Fraternity & Sorority Life Wednesday, January 27, 2016 at 11:59 p.m. 2016 Standards of Excellence Application Guidelines Presented by Fraternity & Sorority Life The annual Standards of Excellence Program is designed to highlight individual and chapter achievements that

More information

APPLICATION FOR PSYCHODYNAMIC PSYCHOTHERAPY TRAINING

APPLICATION FOR PSYCHODYNAMIC PSYCHOTHERAPY TRAINING APPLICATION FOR PSYCHODYNAMIC PSYCHOTHERAPY TRAINING (rev. 7/5/12) PERSONAL INFORMATION P: 646-754-4870 nyupi@nyumc.org Date of Application: First Name: Last Name: Degree/License: HOME PRIVATE OFFICE INSTITUTIONAL

More information

Candidate and Facilitator Standards Policy

Candidate and Facilitator Standards Policy Candidate and Facilitator Standards Policy Practicing Within the Scope of Existing Licensing, Training and/or Certification: The Daring Way is a curriculum that should be used in conjunction with existing

More information

Bucks County Drug Court Program Application

Bucks County Drug Court Program Application Docket Number(s) Bucks County Drug Court Program Application Please read each question carefully before answering. Failure to complete all required Drug Court forms and questionnaires accurately will delay

More information

AUXILIARY AIDS PLAN FOR PERSONS WITH DISABILITIES AND LIMITED ENGLISH PROFICIENCY

AUXILIARY AIDS PLAN FOR PERSONS WITH DISABILITIES AND LIMITED ENGLISH PROFICIENCY AUXILIARY AIDS PLAN FOR PERSONS WITH DISABILITIES AND LIMITED ENGLISH PROFICIENCY PURPOSE This plan provides the policies and procedures for Directions for Living to ensure: A. That all clients and/or

More information

Application Package Mental Health First Aid First Nations Co-facilitator Training Course

Application Package Mental Health First Aid First Nations Co-facilitator Training Course Application Package Mental Health First Aid First Nations Co-facilitator Training Course Cultural Safety: Becoming a Mental Health First Aid (MHFA) First Nations Co-facilitator ------------------------------------

More information

EDITION SPECIAL INSIDE

EDITION SPECIAL INSIDE SUMMER 2008 Increase in Utilization of Crown Build-ups and Changes in Utilization Following an Audit Credentialing Tips and Reminders Online Fee Filing SPECIAL DELTA DENTAL OF MINNESOTA EDITION INSIDE

More information

DENTAL HYGIENE. Program Information and Application. 271 Scott Swamp Road Farmington, CT Admissions Office

DENTAL HYGIENE. Program Information and Application. 271 Scott Swamp Road Farmington, CT Admissions Office DENTAL HYGIENE Program Information and Application 271 Scott Swamp Road Farmington, CT 06032 www.tunxis..edu Admissions Office 860-773-1490 Tunxis Community College does not discriminate on the basis of

More information

When is the best time to contact you? Note: You will not be disqualified from a position automatically for having a conviction or pending

When is the best time to contact you? Note: You will not be disqualified from a position automatically for having a conviction or pending Peace of Mind Nannies, LLC. 1260 Independence Way Sun Prairie, WI 53590 608-217-0537 ashley@peaceofmindmadison.com www.peaceofmindmadison.com 1 Nanny Application This application gives you, as well as

More information

Physical Therapist Assistant Renewal/Reinstatement Application

Physical Therapist Assistant Renewal/Reinstatement Application Vermont Secretary of State Attn: Renewal Clerk Office of Professional Regulation 89 Main St. 3 rd Floor Montpelier, VT 05620-3402 Physical Therapist Assistant Renewal/Reinstatement Application Physical

More information

New Client Reformer Session Packet

New Client Reformer Session Packet New Client Reformer Session Packet Welcome and thank you for your interest in the Pilates Reformer program with University Recreation. You are taking the first steps towards improved health and wellness.

More information

2012 Dental Hygiene Program Application

2012 Dental Hygiene Program Application 2012 Dental Hygiene Program Application Dear Dental Hygiene Applicant: Thank you for applying to the Dental Hygiene Program at Iowa Central Community College. In order to be considered for the 2012 Dental

More information

SORORITY RECRUITMENT. Presented to HPHS Senior Girls

SORORITY RECRUITMENT. Presented to HPHS Senior Girls SORORITY RECRUITMENT Presented to HPHS Senior Girls January 22, 2018 What are Sororities? The oldest sororities were founded in the late eighteen hundreds as women s fraternities. In fact, several of these

More information

Certificate IV in Mental Health Peer Work CHC43515 Scholarships Application Form

Certificate IV in Mental Health Peer Work CHC43515 Scholarships Application Form Mental Health Coordinating Council (MHCC) Learning & Development ABN 592 791 68647 RTO Code 91296 Certificate IV in Mental Health Peer Work CHC43515 Scholarships Application Form MHCC is offering scholarship

More information

Phone Numbers: (work) (cell/home) Phone Numbers: (work) (cell/home)

Phone Numbers: (work) (cell/home) Phone Numbers: (work) (cell/home) CLARKSON COLLEGE Institutional Review Board (IRB) Application INSTRUCTIONS: Applicants, please complete the following sections accordingly Section 1 and Section IV completed by ALL applicants; Section

More information

RECOVERY PROGRAM INFORMATION AND REFERRAL FORM

RECOVERY PROGRAM INFORMATION AND REFERRAL FORM * Note: For the Men s Recovery Program, at this time, we are accepting 1) Fayette county court-ordered clients, 2) clients referred by the KY Department of Corrections, 3) clients referred by Fayette Co.

More information

Juvenile Diversion Program Leader Handbook. (Based on a successful program in the Viking Council, Minneapolis, MN)

Juvenile Diversion Program Leader Handbook. (Based on a successful program in the Viking Council, Minneapolis, MN) Juvenile Diversion Program Leader Handbook (Based on a successful program in the Viking Council, Minneapolis, MN) 1 Table of Contents MISSION STATEMENT... 3 PROGRAM BACKGROUND... 4-8 VOLUNTEER LEADERSHIP...

More information

REALTIME REPORTING. programs offered. Bachelor of Science Degree

REALTIME REPORTING. programs offered. Bachelor of Science Degree Bachelor of Science Degree The baccalaureate degree in Realtime Reporting is designed to meet the specified base of Judicial Reporting Program minimum standards as set out in the National Court Reporters

More information

DIAGNOSTIC MEDICAL SONOGRAPHY PROGRAM APPLICATION PACKET

DIAGNOSTIC MEDICAL SONOGRAPHY PROGRAM APPLICATION PACKET DIAGNOSTIC MEDICAL SONOGRAPHY PROGRAM APPLICATION PACKET The Diagnostic Medical Sonographer (Ultrasound Technologist) is a skilled person qualified by academic and clinical education to provide patient

More information

Home Sleep Test (HST) Instructions

Home Sleep Test (HST) Instructions Home Sleep Test (HST) Instructions 1. Your physician has ordered an unattended home sleep test (HST) to diagnose or rule out sleep apnea. This test cannot diagnose any other sleep disorders. 2. This device

More information

PSYCHOLOGY HUMAN SUBJECT POOL AY

PSYCHOLOGY HUMAN SUBJECT POOL AY General Features of the Psychology Human Subject Pool The Psychology Human Subject Pool (Subject Pool) provides a system for coordinating enrollment in Department research involving human subjects. The

More information

The AHRA Fellow designation recognizes the significant contributions of AHRA members to our professional association.

The AHRA Fellow designation recognizes the significant contributions of AHRA members to our professional association. Application for Fellow Status The AHRA Fellow designation recognizes the significant contributions of AHRA members to our professional association. Using the evaluation point scale and form on the following

More information

Hear land Men s Recovery Center

Hear land Men s Recovery Center Hear land Men s Recovery Center Page 1 of 6 Please read and follow these important guidelines: 1. Complete the 5-page application. Mail or fax it back to us at the address or number above, along with copies

More information

NC General Statutes - Chapter 90 Article 16 1

NC General Statutes - Chapter 90 Article 16 1 Article 16. Dental Hygiene Act. 90-221. Definitions. (a) "Dental hygiene" as used in this Article shall mean the performance of the following functions: Complete oral prophylaxis, application of preventive

More information

CHILDREN'S ADVOCACY CENTER of Laredo Webb County Volunteer Application

CHILDREN'S ADVOCACY CENTER of Laredo Webb County Volunteer Application CHILDREN'S ADVOCACY CENTER of Laredo Webb County Volunteer Application Thank you for your interest in volunteering with the Children s Advocacy Center of Laredo-Webb County. We look forward to working

More information

September 27, Dear Prospective Student:

September 27, Dear Prospective Student: September 27, 2017 Dear Prospective Student: City Colleges of Chicago s Dental Hygiene Program is now accepting applications for the class of 2020, which will enter the program in the 2018 summer session.

More information

1 P a g e. To Whom It May Concern:

1 P a g e. To Whom It May Concern: 1 P a g e To Whom It May Concern: The Board of Directors and Medical Advisory Committee of the National Lymphedema Network (NLN ) are pleased that you are interested in becoming an NLN Affiliate Training

More information

Alabama Certified Peer Specialist Training Application

Alabama Certified Peer Specialist Training Application Alabama Certified Peer Specialist Training Application Full Name: Address Telephone: Cell Phone: Email: Note: Training is open to individuals who are interested in and willing to pursue employment as a

More information

DRUG COURT PARTICIPANT HANDBOOK

DRUG COURT PARTICIPANT HANDBOOK 5 TH JUDICIAL DISTRICT DRUG COURT PARTICIPANT HANDBOOK LYON AND CHASE COUNTIES OCTOBER 2005 MISSION STATEMENT Drug Court in the 5 th Judicial District will strive to reduce recidivism of alcohol and drug

More information

West Loop Life Coaching Inc. Doukessa Lerias, Certified Professional Life Coach (ACC)

West Loop Life Coaching Inc. Doukessa Lerias, Certified Professional Life Coach (ACC) Dear Client, Welcome to West Loop Life Coaching! Thank you for choosing me as your coach. I consider your choice a great privilege to me and I have great respect for the relationship that we have already

More information

2009 ANNUAL SCHOLARSHIP AWARD FOR HIGH SCHOOL SENIORS WITH A HEARING LOSS

2009 ANNUAL SCHOLARSHIP AWARD FOR HIGH SCHOOL SENIORS WITH A HEARING LOSS 1 http://hearingloss-nj.org/ 2009 ANNUAL SCHOLARSHIP AWARD FOR HIGH SCHOOL SENIORS WITH A HEARING LOSS The is pleased to announce a scholarship for high school seniors with a hearing loss, who are pursuing

More information

Application for BSW Practice and Field Courses The School of Social Work at Bridgewater State University

Application for BSW Practice and Field Courses The School of Social Work at Bridgewater State University Application for BSW Practice and Field Courses The School of Social Work at Bridgewater State University Name (printed) Banner ID# Date Form Completed By Student: Date Received by School of Social Work:

More information

(4) Be as detailed as necessary to provide history of work performed; and:

(4) Be as detailed as necessary to provide history of work performed; and: www.omarfigueroa.com Page 66 of 278 (4) Be as detailed as necessary to provide history of work performed; and: (A) Include information adequate to identify any associated manufacturing facility (e.g.,

More information

Conway Grand Strand Georgetown

Conway Grand Strand Georgetown Expanded Duty Dental Assisting Program Information Session Completely view this information presentation Please view this presentation in its entirety. It contains very important information on regarding

More information

Veterans Certified Peer Specialist Training

Veterans Certified Peer Specialist Training Please read the CPS Application Supplement before completing application. Go to http://www.viahope.org/resources/peer-specialist-training-application-supplement This training is intended for individuals

More information

ADMISSIONS POLICIES ADMISSIONS CRITERIA

ADMISSIONS POLICIES ADMISSIONS CRITERIA ADMISSIONS CRITERIA ADMISSIONS POLICIES The Louisiana College PTA program selects a maximum of 24 students each year to enroll in the technical education component of the program. To ensure that the PTA

More information