Welcome to the HPER Online Assistantship Application

NOTE: This form is for students interested in applying for a School of HPER assistantship.

Please review the questions on this form and submit it only if you can complete all the sections which pertain to you. If you are unable to answer the questions at this time, bookmark this page and return when you have the necessary information.

Please supply information on this form down to, and including, the question which asks if you wish to be considered for an Indiana University assistantship. If you do not wish to apply for an assistantship, you do not need to provide information beyond that point. Simply read the information at the bottom of the form under Departmental Information and then submit this form.

NOTE: This application is for new and returning master's and doctoral students.

NOTE TO APPLIED HEALTH SCIENCE: The department of AHS seldom reappoints returning master students that had an appointment for two semesters (one academic year). Please see the department if you have any questions.

First Name: *	Last Name: *
Current Address:
Current City:	Current State:	Current Zip Code:

Current Country:
Permanent Address:
Permanent City:	Permanent State:	Permanent Zip Code:

Permanent Country:
Email Address: *
Student ID Number :
Degree Level: Masters Doctoral
Degree Program: Adapted Physical Education Applied Sport Science Athletic Administration/Sport Management Athletic Training Behavioral, Social, and Community Health (MPH) Biomechanics Biostatistics (MPH) Environmental Health (MPH) Epidemiology (MPH) Ergonomics Exercise Physiology Health Promotion Human Development and Family Studies Motor Learning/Control Nutrition Science Outdoor Recreation Park/Recreation Administration Physical Activity, Fitness and Wellness Public Health (MPH) Public Health Administration (MPH) Recreational Sports Administration Safety Management School and College Health Programs Therapeutic Recreation Tourism Management Adapted Physical Education Biomechanics Environmental Health Epidemiology Exercise Physiology Health Behavior Leisure Behavior Motor Learning/Control Sport Management
Do you currently have a student academic appointment with the School of HPER? (check if yes)

For what academic year are you applying? *
If you would like a specific semester (fall, spring, summer), comment here:
If you have academic honors and/or honorary organizations, list them here :
Please list your major extracurricular activities, which would include volunteer work and offices held:
Foreign Languages Native Languages: Languages you are able to translate: Languages you can speak: Languages you can read: Languages you can write:

Dates you may be reached at the address listed as your current address: Dates you may be reached at the address listed as your permanent address:
Graduate Work Study - Financial Aid Forms I understand the FAFSA (Free Application for Federal Student Aid) must be completed by all new students who are US citizens applying for assistantships. This must be submitted no later than the March 1st deadline. Visit http://www.fafsa.ed.gov/ for more information. This form has been submitted. Reason not submitted:
Professional Experience List practical experiences and work experiences (i.e., camp, YMCA, clerical, public health). Use the format shown to the left of the entry area. Type N/A when you do not have information for a requested item. Leave a blank line between each experience.
Position/Title Employer Dates
Teaching Experience List teaching experiences at each level. Use the format shown to the left of the entry area. Type N/A when you do not have information for a requested itme. Leave a blank line between each experience.
College Level
Years Course Titles Taught
Senior High School Level
Years Course Titles Taught
Junior High School Level
Years Course Titles Taught
Elementary School Level
Years Course Titles Taught
Other
Years Course Titles Taught
Computer Skills List computer programs with which you are familiar including word processing, database, graphics or statistical: Indicate the overall level of your computer competence: 1 (None) 2 (Minimum) 3 (Moderate) 4 (Extensive) 5 (Can Teach)
Other Experience List other experiences such as leadership in workshops, conferences, and other service activities. Use the format shown to the left of the entry area. Type N/A when you do not have information for a requested item. Leave a blank line between each experience.
Role Played Event Dates Blank Line

Note: Please make sure your application is filled out completely. You will not be able to edit this application once you submit it.

* Indicates required field

Applied Health Science/Environmental Health Indicate areas and type of certificate in which you are qualified (certified) to teach or work:
First Aid	Standard Certificate:
First Aid	Instructor's Certificate:
Health Science Content Areas
School Health Education
Public Health Education
Other areas and certifications
Professional writing experience

Kinesiology
Teaching Experience Rate your teaching ability in each activity. 1 = activities in which you have teaching experience 2 = activities you are well qualified in and willing to teach 3 = activities in which you have adequate teaching skills and could teach if necessary 4 = activities you have no ability or interest in teaching
Individual/Dual Sports
1 2 3 4	Archery
1 2 3 4	Badminton
1 2 3 4	Bass Fishing
1 2 3 4	Bicycling
1 2 3 4	Billiards
1 2 3 4	Bowling
1 2 3 4	Fencing
1 2 3 4	Golf
1 2 3 4	Racquetball
1 2 3 4	Riflery
1 2 3 4	Squash
1 2 3 4	Tennis
1 2 3 4	Trap & Skeet
Team Sports
1 2 3 4	Basketball
1 2 3 4	Soccer
1 2 3 4	Volleyball
Gymnastics
1 2 3 4	Apparatus
1 2 3 4	Stunts & Tumbling
1 2 3 4	Trampoline
Physical Development
1 2 3 4	Fitness & Jogging
1 2 3 4	Conditioning
1 2 3 4	Weight Training
1 2 3 4	Aerobic Dance
Aquatics
1 2 3 4	ARC/WSI
1 2 3 4	ARC Instructor Trainer
1 2 3 4	Aquatic Conditioning
1 2 3 4	Diving
1 2 3 4	Scuba (Certified Instructor)
1 2 3 4	Swimming
1 2 3 4	Water Polo
1 2 3 4	Lifeguard Training
1 2 3 4	Sailing
1 2 3 4	Rowing (Sculling)
Martial Arts
1 2 3 4	Hapkido
1 2 3 4	Judo
1 2 3 4	Karate
1 2 3 4	Self-Defense
1 2 3 4	T'ai Chi Chuan
1 2 3 4	Yoga
Dance
1 2 3 4	Jazz
1 2 3 4	Ballroom & Social
1 2 3 4	Folklore & Square
1 2 3 4	Modern, Beginning
1 2 3 4	Modern, Intermediate
1 2 3 4	Tap
Laboratory Experience
Biomechanics Exercise Physiology Measurement/Statistics Motor Learning/Motor Control Sport Psychology
Red Cross Certification Indicate home chapter and expiration date for any certifications you may have:
Lifeguard Training	Home Chaper: Expiration Date:
Water Safety Instructor	Home Chaper: Expiration Date:
First Aid	Expiration Date:
CPR	Expiration Date:
Adapted Physical Education Assistantships Indicate the area(s) in which you have had experience.
Emotionally Disturbed	School Camp
Mentally Retarded	School Camp
Physically Handicapped	School Camp
Other:

Recreation, Park, and Tourism Studies Check the leve of your research competence:
Review literature:	No experience Could assist No supervision needed
Design study:	No experience Could assist No supervision needed
Collect data:	No experience Could assist No supervision needed
Analyze data:	No experience Could assist No supervision needed
Writing up results:	No experience Could assist No supervision needed