Sport and Exercise Science Undergraduate Practicum Application Packet Instructions
|
|
- Russell Nichols
- 6 years ago
- Views:
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:
Florida Agricultural and Mechanical University First Year Experience Peer Mentor Program Application & Information Packet
Florida Agricultural and Mechanical University First Year Experience Peer Mentor Program 2015-2016 Application & Information Packet Thank you for your interest in becoming a FAMU Peer Mentor. Currently,
More informationPeer 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 informationAPPLICATION PROCESS PHASE 1. Students who do not meet the fol owing requirements may not continue with Phase 2 of the application process.
APPLICATION PROCESS The Athletic Training Program (ATP) is a rigorous and time intensive major with a strong academic emphasis. It is necessary for students to have a strong understanding of anatomy and
More informationUniversity 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 informationRPSGT Recertification Application
RPSGT Recertification Application RPSGT: RESPECTED WORLDWIDE AS THE LEADING CREDENTIAL FOR POLYSOMNOGRAPHIC TECHNOLOGISTS Please be sure to read the BRPT Recertification Guidelines located at www.brpt.org
More informationM.Ed. in SPECIAL EDUCATION
HUMAN DEVELOPMENT AND CHILD STUDIES SCHOOL OF EDUCATION AND HUMAN SERVICES M.Ed. in SPECIAL EDUCATION ASD Concentration (Endorsement) INFORMATION AND APPLICATION PACKET HUMAN DEVELOPMENT AND CHILD STUDIES
More informationARAPAHOE COMMUNITY COLLEGE PHYSICAL THERAPIST ASSISTANT PROGRAM 2018 Application for Admission
ARAPAHOE COMMUNITY COLLEGE PHYSICAL THERAPIST ASSISTANT PROGRAM 2018 Application for Admission Please make sure all written information is legible. The PTA program is not responsible for mailing errors
More informationSt. Mary s Hospital Foundation Scholarship Program. Deadline: Must be postmarked by March 15, 2016
St. Mary s Hospital Foundation Scholarship Program Deadline: Must be postmarked by March 15, 2016 MedStar St. Mary s Hospital Human Resources Department 25500 Point Lookout Road Leonardtown, MD 20650 For
More informationMERIDIAN COMMUNITY COLLEGE PYSICAL THERAPIST ASSISTANT PROGRAM APPLICATION
MERIDIAN COMMUNITY COLLEGE PHYSICAL THERAPIST ASSISTANT PROGRAM APLICATION 2018-2019 MERIDIAN COMMUNITY COLLEGE PYSICAL THERAPIST ASSISTANT PROGRAM APPLICATION 2018-2019 The Physical Therapist Assistant
More informationPART A: PERSONAL INFORMATION:
DOÑA ANA COMMUNTIY COLLEGE DENTAL HYGIENE PROGRAM APPLICATION Demographic Information Please type or write legibly DATE OF APPLICATION: PART A: PERSONAL INFORMATION: 1. NAME Aggie ID# Last First Middle
More informationDental Assisting Program Admission Application Packet (High School)
Dental Assisting Program Admission Application Packet (High School) You ve probably watched the pre-enrollment orientation and decided this is the program for you. We re excited to have you in our program!
More informationDENTAL HYGIENE APPLICATION AND INFORMATION PACKET FALL 2018 Dental Programs
DENTAL HYGIENE APPLICATION AND INFORMATION PACKET FALL 2018 Dental Programs 3400 Highway 95, Bullhead City, AZ 86442 APPLICATION SUBMISSION INFORMATION... 2 IMPORTANT REMINDERS... 2 SCHEDULE... 2 REQUIREMENTS
More informationHELP START INTRODUCTORY-LEVEL BIOLOGY AND
HELP START INTRODUCTORY-LEVEL BIOLOGY AND CHEMISTRY STUDENTS ON THE RIGHT FOOT APPLY TO BE AN HHMI PEER MENTOR As an HHMI Peer Mentor, you will have the opportunity to: Work closely with small groups of
More informationRPSGT 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 informationRADIOLOGIST 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. 1. Applications will not be processed unless all instructions
More informationSaint Mary s College High Potential Program Peer Mentor (FWS Position)
1 Saint Mary s College High Potential Program 2013-2014 Peer Mentor (FWS Position) THE HIGH POTENTIAL PROGRAM: The High Potential (HP) Program includes a Summer Bridge Program that provides access, admission
More informationRADIOLOGIST 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. Applications will not be reviewed by the Radiologist Assistant
More informationNote: 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 informationCOAHOMA COUNTY SCHOOL DISTRICT Application for Interim Superintendent of Schools
COAHOMA COUNTY SCHOOL DISTRICT Application for Interim Superintendent of Schools (Please type or print your responses and fully respond to each item.) I. BASIC INFORMATION Name: (Last) (First) (Middle)
More informationVOLUNTEER PROGRAM. Anthony Vandenberg Harmony Home CAC PO Box 3087 Odessa, TX C South Grant Odessa, TX 79761
VOLUNTEER PROGRAM Program Mission: To provide diverse and flexible opportunities to those interested in volunteering their time and unique talents towards the fight against child abuse. Thank you for choosing
More informationDENTAL CLINICAL RESIDENCY PROGRAMME
DENTAL CLINICAL RESIDENCY PROGRAMME PROGRAMME DETAILS & RESIDENT APPLICATION FORM FACULTY OF DENTISTRY UiTM Sg Buloh, Jalan Hspital, 47000 Sungai Buloh, Selangor Malaysia Programme Details & Resident Application
More informationApplication 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 informationNational 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 informationAPPLICATION 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 informationDear 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 informationHello! 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 informationCentennial 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 informationHealth Sciences Program Application Associate in Science Degree in Respiratory Care
Health Sciences Program Application Associate in Science Degree in Respiratory Care For admission consideration, you must submit this application with any required documentation and have all of your grades
More informationSOCIAL 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 informationPlease read the following requirements for this program.
Please read the following requirements for this program. REQUIREMENTS FOR PRACTICUM IN FORENSIC SCIENCE COURSE NUMBER: FRSC 4900 COURSE DESCRIPTION: Credit is for 3 hours. Subject matter will vary according
More informationChild Life Practicum
Child Life Practicum Thank you for your interest in the Child Life Practicum at Anne Arundel Medical Center in Annapolis, MD. This practicum program will allow a student insight into the daily duties of
More informationDENTAL 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 informationCITY 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 information2017 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 informationDear Applicant, If you have any questions, feel free to call (509) Sincerely, Steven Hansen WSU PD Assistant Chief
Dear Applicant, Thank you for expressing interest in the Washington State University Police Department Internship Program. The Program was developed by the WSU Police Department to offer an opportunity
More informationAssociate 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 informationTraining Announcement Peer Specialist Certification Training
Georgia Department of Behavioral Health & Developmental Disabilities Judy Fitzgerald, Commissioner Office of the Commissioner 2 Peachtree St., NW, 24-290, Atlanta, Georgia 30303-3142 ~ 404.463.7945 Training
More informationDEPARTMENT 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 information2017 National ASL Scholarship
Eligibility Statement 2017 National ASL Scholarship Deadline: May 5, 2017 Undergraduate students currently majoring or minoring in American Sign Language, Deaf Studies, Deaf Education, or Interpreter Preparation
More informationDear Prospective Volunteer,
Dear Prospective Volunteer, Thank you for your interest in the Volunteer Program at Texas Scottish Rite Hospital for Children. We have certain requirements that must be completed before volunteering. Please
More informationHazlehurst City School District Application for Superintendent of Schools
Hazlehurst City School District Application for Superintendent of Schools Please type or print your responses and fully respond to each item. I. Basic Information Name (Last) (First) (Middle) Social Security
More informationNational 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 informationAdmission 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 informationPlease 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 informationRADIOLOGIST 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 informationPeer Mentor Position Description
Peer Mentor Position Description General Statement of Duties Peer Mentors (PMs) are live-in, part-time, student staff members within the Residential First- Year Experience residence halls. Peer Mentors
More informationAPPLICATION 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 informationNorth 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 informationNorth Carolina Board of Physical Therapy Examiners Application for Physical Therapist Assistant Licensure
FOR OFFICIAL USE ONLY Name: End: Ex: Rev by End: Exost: Board Approved by: PTA Revive by Exam Application Examination Date: ID Number: Exam Form Number: SCORES: Scaled: / / Raw: / / NC Passing: Scaled:
More informationPLEASE 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 informationMusculoskeletal 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 informationDental 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 informationTRUSTLINE REGISTRY The California Registry of In-Home Child Care Providers Subsidized Application
State of California-Health and Human Services Agency TRUSTLINE REGISTRY The California Registry of In-Home Child Care Providers Subsidized Application California Department of Social Services Community
More informationHenderson 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 informationPETE s PALs. Spring 2017 Clinician Application. Promoting Physical Education for Everyone.
Spring 2017 PETE s PALs Clinician Application Packet 1 PETE s PALs Spring 2017 Clinician Application Promoting Physical Education for Everyone http://www.faithlafayette.org/community/programs/petes_pals
More informationSAVE THE DATE!!!!
www.mhrecovery.org SAVE THE DATE!!!! CERTIFIED PEER SPECIALIST TRAINING IS COMING TO HARRISBURG, PA!!! FACILITATED BY COPELAND CENTER NATIONAL DIRECTOR FOR WELLNESS & EDUCATION, GINA KAYE CALHOUN NOW ACCEPTING
More informationSubstantial 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 informationHenry 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 informationNorth 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 Exam Application Examination Date: / / ID Number: / / Exam Form Number: / / SCORES: Scaled: / / Raw: / / NC Passing: Scaled:
More informationDear Applicant: Sincerely,
Dear Applicant: Thank you for your interest in the Physical Therapist Assistant Program offered at Daytona State College. The PTA Program is accredited by the Commission of Accreditation for Physical Therapy
More informationControlled Substances Program. For Academic Units
Brigham Young University Page 1 Provo, Utah Controlled Substances Program For Academic Units Last Revised: November 30, 2009 Brigham Young University Page 2 TABLE OF CONTENTS Section Title Page 1.0 Overview
More informationGDA Coronal Polishing Enrollment Packet
GDA Coronal Polishing Saturday, March 30, 2019 8 am to 5 pm 8200 Roberts Drive GDA Coronal Polishing Enrollment Packet Thank you for requesting information on the Georgia Dental Association s Coronal Polishing
More informationCrisis 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 informationSUPERIOR COURT OF THE DISTRICT OF COLUMBIA
SUPERIOR COURT OF THE DISTRICT OF COLUMBIA Juvenile Behavioral Diversion Program Description Introduction It is estimated that between 65 to 70% of juveniles involved in the delinquency system are diagnosed
More informationMetropolitan Community College- Penn Valley Physical Therapist Assistant Program Application
Metropolitan Community College- Penn Valley Physical Therapist Assistant Program Application Accredited by: Metropolitan Community College-Penn Valley PHYSICAL THERAPIST ASSISTANT PROGRAM APPLICATION PROCEDURE
More informationApplication for Cadet Membership
Application for Cadet Membership 275 West Main Street P.O. Box 309 Braidwood, IL 60408 815-458-2000 Name: (Print Neatly) Introduction The Braidwood Fire Department consists of dedicated men and women who
More informationFORT HAYS STATE UNIVERSITY DEPARTMENT OF ALLIED HEALTH DIAGNOSTIC CARDIAC SONOGRAPHY PROGRAM
FORT HAYS STATE UNIVERSITY DEPARTMENT OF ALLIED HEALTH DIAGNOSTIC CARDIAC SONOGRAPHY PROGRAM The Fort Hays State University Department of Allied Health is pleased you have expressed interest in the Diagnostic
More informationDENTAL 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 informationPhysical 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 informationDental 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 informationJMC House Advisor Application Information Packet
JMC House Advisor 2018 2019 Application Information Packet TO: All House Advisor (HA) Candidates FROM: Dr. Pat Danylyshyn-Adams, Director of Residence Life Dr. Sonia Rosado and LeRoy Ford, Assistant Directors
More informationBaby-Sitting - $20 Per Day/Per Nanny (local clients) Less than 24 hours notice $30 Per Day/Per Nanny. Hotel Overnight Sitting - $35 per Day/Per Nanny
ALL ABOUT NANNIES BUSINESS PHONE: 602-266-9116 BUSINESS FACSIMILE: 602-266-9787 BUSINESS EMAIL: ADMIN@ALLABOUTNANNIESINC.COM TEMPORARY, BABY-SITTING, HOTEL & ON-CALL AS NEEDED Mother s Full Name: Place
More informationCertified 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 informationRady Children s Hospital- San Diego Child Life Practicum Application Checklist (Please enclose with application)
Applicant Name: Rady Children s Hospital- San Diego Child Life Practicum Application Checklist (Please enclose with application) Completed Child Life Practicum Application Typed Practicum Application Typed
More informationCarrie Havens. Dear Candidate,
Public Safety Training Center Police Agility Program WESTERN CAMPUS 11000 W. PLEASANT VALLEY ROAD PSTC BLDG., STE. 221 PARMA, OH 44130 PHONE: 2169873033 Dear Candidate, Congratulations on your choice of
More informationPHYSICAL 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 informationNorth 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 informationKENTUCKY ADULT PEER SUPPORT SPECIALIST TRAINING:
KENTUCKY ADULT PEER SUPPORT SPECIALIST TRAINING: INFORMATION SHEET/CHECKLIST Description (908 KAR 2:220): Peer support is the social and emotional support provided by persons with a mental health condition
More informationTHE BLOCKWATCH HANDBOOK
THE BLOCKWATCH HANDBOOK Introduction The Blockwatch Handbook was created to provide a written guide for citizens and officers to refer to for the operation of a blockwatch. This handbook cannot provide
More informationArkansas 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 informationTraining Announcement Peer Specialist Certification Training
Georgia Department of Behavioral Health & Developmental Disabilities Frank W. Berry, Commissioner Office of the Commissioner 2 Peachtree St., NW, 24-290, Atlanta, Georgia 30303-3142 ~ 404.463.7945 Training
More informationPARTICIPATION APPLICATION and AGREEMENT for CULINARY SCHOOL PROGRAM
Page 1 PARTICIPATION APPLICATION and AGREEMENT for CULINARY SCHOOL PROGRAM PERSONAL INFORMATION First Name Middle Initial Last Name Current Street Address City State Zip code ( ) CELL _( )_HOME @ Email
More informationMusculoskeletal 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 informationEffective Date: 9/14/06 NOTICE PRIVACY RULES FOR VALUEOPTIONS
Effective Date: 9/14/06 NOTICE PRIVACY RULES FOR VALUEOPTIONS This notice describes how medical information about you may be used and disclosed and how you can get access to this information. If you have
More informationThe proposal affects Texas Occupations Code, Title 3, Subtitle D and Texas Administrative Code, Title 22, Part 5.
Page 1 of 22 TITLE 22.EXAMINING BOARDS Part 5. STATE BOARD OF DENTAL EXAMINERS Chapter 101. DENTAL LICENSURE 22 TAC 101.1-101.7, 101.9 The State Board of Dental Examiners (Board) proposes amendments to
More informationVolunteering at Jonathan s Place
Volunteering at Jonathan s Place Thank you so much for your interest in volunteering to help the abused, abandoned and neglected children assisted by Jonathan s Place. Here are the steps to becoming an
More informationAbout this consent form. Why is this research study being done? Partners HealthCare System Research Consent Form
Protocol Title: Gene Sequence Variants in Fibroid Biology Principal Investigator: Cynthia C. Morton, Ph.D. Site Principal Investigator: Cynthia C. Morton, Ph.D. Description of About this consent form Please
More informationSandra 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 informationIt 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 informationForensic Psychology and the Criminal Justice System May 2018
Forensic Psychology and the Criminal Justice System May 2018 Psychology 3364 May 17 th -June 1 st, 2018 4:30-8:30pm TBD cell: 214-641-9003 (prefer text) Jill Johansson-Love, Ph.D. email: jjohanssonlo@mail.smu.edu
More informationNOTICE OF APPEAL OR PETITION
NOTICE OF APPEAL OR PETITION State Personnel Board 801 Capitol Mall Sacramento, CA 95814 Dismissal Demotion Suspension ( days) Medical Demotion / Termination Automatic Resignation (AWOL) Set Aside Resignation
More informationWe are inviting you to participate in a research study/project that has two components.
Dear TEACCH Client: One of the missions of the TEACCH Autism Program is to support research on the treatment and cause of autism and related disorders. Therefore, we are enclosing information on research
More informationPLEASE 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 information2018 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 informationAPPLICATION FOR 2019 MA (CLINICAL PSYCHOLOGY)
UNIVERSITY OF JOHANNESBURG DEPARTMENT OF PSYCHOLOGY Please attach photo here SECTION A BIOGRAPHICAL PARTICULARS Full Application form must be TYPED and not HANDWRITTEN APPLICATION FOR 2019 MA (CLINICAL
More informationOffice of Multicultural Student Services Peer Mentor Application Fall 2017-Spring 2018 Academic Year
Peer Mentor Application Fall 2017-Spring 2018 Academic Year Office of Multicultural Student Services Lucas Hall 107 Phone: 314-516-6807 Fax: 314-516-4611 multicultural@umsl.edu Peer Mentor Application
More informationFaculty of Social Science Department of Applied Disability Studies ADST 5P76 SUPERVISED PRACTICUM IN APPLIED BEHAVIOUR ANALYSIS
Faculty of Social Science Department of Applied Disability Studies Brock University Niagara Region 1812 Sir Isaac Brock Way St. Catharines ON L2S 3A1 T 905 688 5550 ads@brocku.ca brocku.ca/ads ADST 5P76
More informationSonography 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 informationRound Rock Sertoma General Scholarship Application for Students who are Hard of Hearing or Deaf
Round Rock Sertoma General Scholarship Application for Students who are Hard of Hearing or Deaf Deadline: March 1 of your Senior Year Scholarship Program $1,000 scholarship to cover tuition, books and
More information