| Practicum/Internship Application Instructions |
- Please run copy of application and submit as either an electronic or hard copy.
- Complete entire application.
- Print legibly or type.
- Return to Greg Sferra, Campus Recreation Director, 114 ARC, gregory.sferra@sru.edu
| Date Completed ___________________ |
| Name ______________________________________________________________________________________________ |
| Campus Address _____________________________________________________________________________________ |
| Campus Telephone #: ( ) ____________________________ |
Campus E-Mail ________________________________ |
| Home Address _______________________________________________________________________________________ |
| Home Telephone #: ( ) ____________________________ |
Home E-Mail __________________________________ |
Identify area of Campus Recreation to complete Practicum/Internship:
| ____ Aquatics |
____ Fitness |
____ Facility Management |
| ____ Intramural Sports |
____ Outdoor Adventures |
____ Climbing Wall |
| ____ General Experience |
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| Major: |
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| ____ Exercise Science |
____ Parks and Recreation |
____ Sports Management |
| Other: Please Identify Major: ________________________________________ |
College Class: (Check appropriate Class)
College Class |
Check |
College Enrolled |
Check |
Freshman |
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SRU |
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Sophomore |
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Other College |
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Junior |
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List College enrolled at if not SRU |
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Senior |
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Graduate Student |
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SPECIAL SKILLS (Check appropriate skills)
Skill |
Check |
Skill |
Check |
Skill |
Check |
Aerobic Instructor |
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First Aid/CPR Certification |
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Marketing |
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Fitness Training |
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Personal Computer |
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WSI/Lifesaving |
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Project Adventure |
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Climbing Wall Experience |
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Outdoor Adventure Experience |
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| Sports Officiating |
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List Sports |
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| Other Related Skills |
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List Skills |
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REFERENCES
Please list 3 persons (not related) for whom you have worked and can be called for a reference check.
Projected Practicum Hours
Semester of Practicum: Fall ___, Spring ___, Summer ____, Year 200__
Indicate the times you are interested in working with an “X”
Time |
Sunday |
Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
Saturday |
6-7:00 a.m. |
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7-8:00 a.m. |
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8-9:00 a.m. |
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9-10:00 a.m. |
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10-11:00 a.m. |
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12-1:00 p.m. |
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1-2:00 p.m. |
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2-3:00 p.m. |
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3-4:00 p.m. |
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4-5:00 p.m. |
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5-6:00 p.m. |
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6-7:00 p.m. |
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7-8:00 p.m. |
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8-9:00 p.m. |
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9-10:00 p.m. |
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I hereby authorize investigation of my past record and all statements contained on this application. I certify that all information hereon is true and understand that misrepresentation or omission of fact is sufficient cause for dismissal.
Signature: ______________________________________________ Date: ________________________________________
Please return this application, along with a schedule form to the Office of Campus Recreation, Aebersold Student Recreation Center.
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