Department Of Kinesiology Physical & Health Education Teacher Education Work Experience Verification Form printable pdf download

Department Of Kinesiology Physical & Health Education Teacher Education Work Experience Verification Form

Department of Kinesiology

Physical & Health Education Teacher Education

Work Experience Verification Form

The individual named below has indicated an interest in applying to the Physical & Health Education

Teacher Education program at James Madison University. One of the admission requirements is 50 hours

of quality work experience with children or adolescents. This form is designed to document the type of

work and the amount of hours that the individual performed for you and/or your organization.

Thank you for your time.

Name of JMU student: ___________________________________________________

Address: ________________________________________________ Email: __________________

Name of organization or employer: __________________________________________________

Role or position held by student: __________________________________________________

Dates of service: __________________________________________________

Total amount of hours spent in this position: _____________________________

Please describe the type of work and the responsibilities held by this individual. Also, feel free to give

any other pertinent information related to this person being successful in a teacher education program and

as a future teacher. Thank you.

Name: __________________________________

Title: ________________________________

Signature: _______________________________________________________________________

Address: ________________________________________________________________________

Phone: ________________

Email: ________________

Date: _______________

Please return to:

Coordinator of PHETE, Department of Kinesiology,

261 Bluestone Dr. MSC 2302, James Madison University, Harrisonburg, VA 22807

Department Of Kinesiology Physical & Health Education Teacher Education Work Experience Verification Form