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GRADUATE TEACHING ASSISTANTSHIP FORM AND INTERVIEW PROCESS DEPARTMENT (University of North Carolina at Chapel Hill)

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GRADUATE TEACHING ASSISTANTSHIP FORM AND INTERVIEW PROCESS
DEPARTMENT OF EXERCISE AND SPORT SCIENCE
THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
Name _________________________________ Date _________________________________
Age _________ Male/Female (circle) T-shirt Size __________
Specialization Area __ Athletic Training ___ Exercise Physiology ___ Sport Administration
Permanent Home Address
______________________________________ Phone (home) _________________________
______________________________________ Phone (cell) ___________________________
______________________________________ Email ________________________________
Address You Can be Reached in June/July/August
_______________________________________ Summer phone ________________________
_______________________________________ Summer email _________________________
Undergraduate College(s) attended and graduated from (and location)
_________________________________________________________________________________
_________________________________________________________________________________
Grade Point Average ____________ (international students put down overall passing marks)
GRE Scores VERBAL ____ % ____ QUANTITATIVE ____ % ____ ANALYTICAL ____ % ____
International Students: TOEFL Scores __________
All Applicants
Teaching Experience (Check where appropriate)
___ Student teaching in physical education: Grade Level __________
___ Private lessons and/or camps: Number of years __________
___ Private/Public school teaching Number of years __________
___ Coaching (please specify) ______________________________________________________
___ Other (please specify) _________________________________________________________
LIST ALL CURRENT CERTIFICATIONS (CHECK WHERE APPROPRIATE)
AHA or Red Cross CPR Yes ___ Instructor level _____
Red Cross First Aid Yes ___ Instructor level _____
Physical Therapy (USA) Yes ___
NSCA-CSCS Yes ___
ACSM Yes ___ (if yes, describe) ____________________________________
Coaching Yes ___ (if yes, describe) ____________________________________
Other fitness/aerobics Yes ___ (if yes, describe) ____________________________________
Lifeguard/WSI/aquatics Yes ___ (if yes, describe) ____________________________________
Teaching certification Yes ___ (if yes, describe) ____________________________________
Certified Athletic Trainer Yes ___ (if pending, date expected) ____________________________
Other certifications/licensures _________________________________________________________
Listed below are some of the courses taught in The University of North Carolina Lifetime Fitness/Physical
Activities Program. Please select from these courses those in which you are able to teach, as well as those
you prefer to teach. Please prioritize those classes you would prefer to teach. Please list the skill level
(Beginning, Intermediate, Advanced). If there is a special skill you have, and a similar class is not listed,
please make a special note.
Activity Prefer to Teach/Prioritize Skill Level
___ Aerobics _________________________________ __________
___ Badminton _________________________________ __________
___ Cycling/Spinning _________________________________ __________
___ Exercise & Conditioning _________________________________ __________
___ Gol f _________________________________ __________
___ Indoor Sports _________________________________ __________
(Basketball, Indoor Soccer, Volleyball)
___ Jogging _________________________________ __________
___ Outdoor Sports _________________________________ __________
(Soccer, Flag Football, Ultimate Frisbee)
___ Racquet Sports _________________________________ __________
(Badminton, Racquetball, Tennis)
___ Racquetball _________________________________ __________
___ Ski/Snow Boarding _________________________________ __________
___ Soccer _________________________________ __________
___ Swim Conditioning _________________________________ __________
___ Swimming _________________________________ __________
___ Tennis _________________________________ __________
___ Ultimate Frisbee _________________________________ __________
___ Volleyball _________________________________ __________
___ Walking _________________________________ __________
___ Weight Training _________________________________ __________
___ Yoga/Pilates _________________________________ __________
___ Other _________________________________ __________
PLEASE UPLOAD THIS APPLICATION TO YOUR GRADUATE SCHOOL APPLICATION UNDER SUPPLEMENTAL
DOCUMENTS.
For more information about the Lifetime Fitness/Physical Activities Program, please see our
website at:
http://exss.unc.edu/liftphya
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GRADUATE TEACHING ASSISTANTSHIP FORM AND INTERVIEW PROCESS DEPARTMENT (University of North Carolina at Chapel Hill)

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Completed 8 January 2021

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