Department of Kinesiology
Departmental Graduate / Teaching Assistantship Application
DEMOGRAPHICS
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Undergraduate College or University
Undergraduate Degree
Undergraduate G.P.A.
Is your primary language English?
YES
NO
If English is not your primary language, please provide TOEFL or ETS score
Are You Currently a Graduate Student at WIU?
YES
NO
If currently a graduate student at WIU, indicate the graduate program you are in
Indicate the semester you are in the WIU graduate program:
1st
2nd
3rd
4th
Current G.P.A.
If NO, have you applied to WIU Graduate School?
YES
NO
Identify the desired graduate field of study:
Kinesiology
Sport Management
Indicate the assistantship semester/year for which you are applying:
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CERTIFICATIONS
CPR/AED
YES
NO
Identify the type of certification you have (i.e., Red Cross BLS, American Heart Association Basic, etc.)
Expiration date
FIRST AID
YES
NO
Identify the type of certification you have (i.e., Red Cross, American Heart Association, etc.)
Expiration date
NSCA / CSCS
YES
NO
USAW
YES
NO
BOC ATC
YES
NO
PT / PHYSIOTHERAPY
YES
NO
ACSM
YES
NO
Identify the type of certification you have (i.e., Certified Personal Trainer, Certified Exercise Physiologist, Certified Group Exercise Instructor, etc.)
Expiration date
OTHER (Please identify and explain):
TEACHING EXPERIENCE
AEROBIC CONDITIONING
Interested in teaching
Have teaching experience
Have participation experience
AEROBIC DANCE / ZUMBA / KICKBOXING
Interested in teaching
Have teaching experience
Have participation experience
BADMINTON
Interested in teaching
Have teaching experience
Have coaching experience
Have participation experience
Have refereeing experience
BASKETBALL
Interested in teaching
Have teaching experience
Have coaching experience
Have participation experience
Have refereeing experience
CRICKET
Interested in teaching
Have teaching experience
Have coaching experience
Have participation experience
Have refereeing experience
FLAG FOOTBALL
Interested in teaching
Have teaching experience
Have coaching experience
Have participation experience
Have refereeing experience
FRISBEE
Interested in teaching
Have teaching experience
Have coaching experience
Have participation experience
Have refereeing experience
GOLF
Interested in teaching
Have teaching experience
Have coaching experience
Have participation experience
Have refereeing experience
PICKLEBALL
Interested in teaching
Have teaching experience
Have coaching experience
Have participation experience
Have refereeing experience
SOCCER
Interested in teaching
Have teaching experience
Have coaching experience
Have participation experience
Have refereeing experience
TEAM HANDBALL
Interested in teaching
Have teaching experience
Have coaching experience
Have participation experience
Have refereeing experience
TENNIS
Interested in teaching
Have teaching experience
Have coaching experience
Have participation experience
Have refereeing experience
VOLLEYBALL
Interested in teaching
Have teaching experience
Have coaching experience
Have participation experience
Have refereeing experience
STRENGTH AND CONDITIONING
Interested in teaching
Have teaching experience
Have coaching experience
Have participation experience
Have refereeing experience
Have certification
OLYMPIC LIFTING
Interested in teaching
Have teaching experience
Have coaching experience
Have participation experience
Have refereeing experience
Have certification
PERSONAL/GROUP FITNESS
Interested in teaching
Have teaching experience
Have coaching experience
Have participation experience
Have certification
STRESS MANAGEMENT
Interested in teaching
Have teaching experience
ANATOMY AND PHYSIOLOGY LAB
Interested in teaching
Have teaching experience
ATHLETIC TRAINING CLINICAL / LAB / ASSESSMENT EXPERIENCE
Interested in teaching
Have teaching experience
DIETETICS / NUTRITION LAB
Interested in teaching
Have teaching experience
PHYSIOLOGY OF EXERCISE LAB
Interested in teaching
Have teaching experience
ADAPTED PHYSICAL EDUCATION (MOTOR CLINIC)
Interested in teaching / Assisting Motor Clinic
Have teaching experience
INDUSTRIAL ATHLETIC TRAINING
Interested in expanding AT skills in industrial settings
Have clinical experience
Have BOC certification
HIGH SCHOOL STRENGTH AND CONDITIONING
Interested in teaching
Have coaching experience
Have CSCS certification
OTHER COACHING, PHYSICAL ACTIVITY OR SPORT EXPERIENCES
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WORK HISTORY
LIST YOUR WORK EXPERIENCE
ATTACH RESUME (WORD/PDF ONLY)
Browse Files
Cancel
of
LIST YOUR LABORATORY EXPERIENCES (i.e., EKG, VO2max, Body Composition, etc.)
LIST ANY PERTAINING ADDITIONAL EXPERIENCES / INFORMATION
PROVIDE NAME, POSITION, EMAIL AND PHONE NUMBER FOR THREE PROFESSIONAL REFERENCES
Please verify that you are human
*
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