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.
Please return to:
Coordinator of PHETE, Department of Kinesiology,
261 Bluestone Dr. MSC 2302, James Madison University, Harrisonburg, VA 22807