MIDWEST AMERICAN COLLEGE OF SPORTS MEDICINE

LEADERSHIP & MENTORING PROGRAM

LEVEL 2

GENERAL INFORMATION

The purpose of the MWACSM Leadership & Mentoring Program Level 2 is to encourage Master level, Ph.D., and M.D./D.O. candidates who are also MWACSM student members of diverse backgrounds to participate in activities that will lead to increased MWACSM service, enhanced pathways to degree completion, and successful post-terminal degree experiences.

Eligibility for Level 2Program:

All applicants must meet the following general criteria:

1)Be a citizen, citizen national, or permanent resident of the U.S. or Canada

2)Enrolled in Master or Ph.D. program in a sports medicine (e.g., Athletic training, occupational therapy, or physical therapy), exercise science, activity epidemiology, or a related field OR a M.D. or D.O. program

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MWACSM L&MP Level 2

MIDWEST AMERICAN COLLEGE OF SPORTS MEDICINE

LEADERSHIP & MENTORING PROGRAM

LEVEL 2

REQUIRED APPLICATION MATERIALS

Required Application Materials For the Program:

1)Completed application form.

2)At least two letters of recommendation, one of which is from the student’s advisor or from another professor, department chair, academic dean, or individual who is familiar with the applicant’s capabilities and work ethic. Recommendation letters can be sent directly to the Chair of the MWACSM Leadership and Mentorship Ad Hoc Committee (see below).

3)A description of how you intend to exhibit your dedication to the goals and long-range activities of MWACSM (1200-word maximum). For example, committees on which you would like to serve, participation in annual meeting activities, or anything else that describes your desired future MWACSM participation. Please be as specific as possible.

4)If applicable, a summary of participation in professional development activities especially those associated with service to MWACSM.

5)A current CV.

Note: Since many applicants provide outstanding recommendations, the description written by the candidate serves as a key discriminator among closely qualified applicants.

Application Deadline: The application deadline isSeptember15 of each year. Please email the completed application, including all required items, to the Chair of the MWACSMLeadership Ad Hoc Committee, Dr. Karin Pfeiffer, . Incomplete applications will not be reviewed. Candidates will be notified of acceptance by October 1 of each year.

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MWACSM L&MP Level 2

MIDWEST AMERICAN COLLEGE OF SPORTS MEDICINE

LEADERSHIP & MENTORSHIP PROGRAM

LEVEL 2

APPLICATION FORM

Please complete and return with other application materials.

RACIAL OR ETHNIC IDENTITY (Please check all that apply):

____ Hispanic or Latino _____ American Indian _____ Caucasian _____ Asian

_____ Native Hawaiian or Other Pacific Islander _____ Black or African American

NAME: ______

MAILING ADDRESS: ______

______

______-______

TELEPHONE NUMBER: ______FAX NUMBER: ______

EMAIL: ______

AREA OF INTEREST/CONCENTRATION/MAJOR: ______

PRESENT COLLEGE OR UNIVERSITY/EMPLOYER: ______

EDUCATIONAL HISTORY

Institution / Degree / Date Received/Anticipated

REFERENCES(third reference only if applicable)

Name / Institution / MWACSM Member? (Y or N) / ACSM Fellow? (Y or N)

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MWACSM L&MP Level 2

MIDWEST AMERICAN COLLEGE OF SPORTS MEDICINE

LEADERSHIP & MENTORING PROGRAM

LEVEL 2

If accepted, I will:

  • Be assigned a mentor (ACSM Fellow for Ph.D. level)
  • Receive registration for and attend the MWACSM Annual Meeting
  • Receive a free year MWACSM membership including member benefits
  • Learn about MWACSM leadership structure and participating in regional and national meetings
  • Participate inrecruitment activitiesand other duties as assigned by the MWACSM Board of Directors or Ad Hoc Leadership Committee
  • Submit a final report regarding activities for the MWACSM Annual Meeting. (Report due two weeks after the last day of the MWACSM Annual Meeting)
  • Submit a final report regarding activities for the year. (Report due September 1 of the following year)

I will also work toward the following outcomes:

  • Becoming more familiar with MWACSM and ACSM leadership structure
  • Will accept being introduced to and interact with MWACSM leaders and potential future leaders
  • Play a significant role in recruiting other students of into the profession and have an important role in enhancing MWACSM membership
  • Will consider applying for the Level 3 program upon completion of Level 2
  • Attend the next MWACSM Annual Meeting.

______

Signature Date

The signature of the applicant above confirms that the information stated in this application is the truth.

MIDWEST AMERICAN COLLEGE OF SPORTS MEDICINE

LEADERSHIP & MENTORING PROGRAM

LEVEL 2

GUIDELINES FOR RECOMMENDATION

Instructions for completion of letters of recommendations for program:

1) Please include in body of letter:

Applicant’s Name

Your Name

Title/Position/Institution

Whether you are a MWACSM member and ACSM member and/or ACSM Fellow

2) Please provide the following information:

How long and in what capacity have you known the applicant?

Describe the quality of the applicant's work.

What is the applicant's level of productivity?

Please evaluate the applicant's level of interest and long-term potential to contribute to MWACSM

3) In the letter please rate the applicant according to:

General Knowledge

Leadership Skills and Potential

Persistence toward Goals

Maturity

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MWACSM L&MP Level 2