DHS Sports Medicine Club / National Honors Society of Sports Medicine (NHSSM)
Application for the 2016-2017 school year
Application Due: Friday, March 18, 2016
Name: ______Current Grade ____ School: DHS SLHS PCHS
(Circle one)
Email address (prefer gmail acct.): ______
Cell Phone #: (______)______(not required) Current GPA _____ Overall GPA _____
The purpose of this organization is to create enthusiasm for scholarship in the area of sports medicine and other fields directly related to sports medicine, to stimulate a desire to render service in the community, to promote leadership, and to assist in the development of character in the students of secondary schools.
Requirements to Apply:Students may apply for membership if they are sophomores, juniors or seniors
with a minimum cumulative GPA of 3.0.Students may participate in sports, but no
more than one sport or in a year round sport.
All parts of this form must be completed. Do not leave anything blank. Please follow all of the directions carefully to assure proper consideration. Submitting an application does not guarantee membership.
Expectations of Club Members and Club Information:
It is our recommendation that an applicant be passionate and curious about the field of sports medicine. This club is very time consuming and it is a big commitment. We recommend at least 2-3 Shadow Days in April. We always work with our students and want to be sure that they are successful in the classroom. School comes first!
If you become an NHSSM member, you are expected to attend all meetings even if you are participating in a sport, be in the ATR on time when you are scheduled a minimum of 3 days a week (Monday- Saturday), and maintain a 3.0 GPA. Failure to actively participate or maintain the minimum GPA will result in loss of NHSSM recognition and dismissal from the Club. In addition, you are also expected to participate in our group service project for NHSSM at the Holiday Half Marathon in December with Pomona Valley Hospital Medical Center. Our work for PVHMC does count for Christian Service Hours.
As an NHSSM member of our Sports Medicine Club, you will have the opportunity to compete at the St. Francis Sports Medicine Competition. The top ten schools and top five students in the competition get to move on to compete at the national level. You will also be able to join the Sports Medicine field trip for the NHSSM Sports Medicine High School Conference at the Staples Center. Both events are held usually in March-April.
In this club, you will work side by side with the DHS certified athletic trainers and university athletic training students. You will learn basic first aid, taping skills, CPR and how to assist the AT in an emergency situation. We rely on our Club students to be the eyes and ears for us on multiple fields at the same time. The club membership is like a part time job. We are a team! We expect students to be on time when they are scheduled, give us updates of their availability so we can make an accurate schedule, and find another teammate to cover their shift if something comes up last minute. Some shifts may include late nights, weekends and holidays. Students will never work alone. A Certified Athletic Trainer will always be present.
After 2 years with the Club or a student has proved themselves to be an outstanding leader within the club, students will also receive their Varsity Letter in Sports Medicine.
Confidential information about character from the faculty and administration may also be considered. This information will be provided to the faculty admitting committee. All information in this application is held confidential within the Sports Medicine admitting staff.
Name: ______Grade: ______Date: ______
Part I - Activities
Please list all extracurricular activities that you plan on participating in during the 2016-2017 school year. This includes, ASB, jobs, clubs, athletics (club sports and school), choir, etc…
Activity Days / Dates/ Season Involved
Part II – Faculty recommendations
“I recommend the above student to join a National Honors Society Club!”
Print Teacher’s Name How do they know you? # of years known? Comments Signature
Name: ______Grade: ______Date: ______
Part III – Student Information
- Do you drive to school? ______
- PC or SL students only. If you drive, would you be willing (if granted parent permission) to take other sports medicine club students from your school to Damien? ______
- Are you available to work in the athletic training room (ATR) late nights (after 7pm) and/ or Saturday’s? ______If not, why?______
- What days are you available to be in the ATR on a regular basis (Monday – Saturday)?DHS Students are expected to report to the ATR after school by 3pm and PC/SL students are to report by 3:30pm. Some students may report later for a late evening shift. ______
- Do you have Latex Allergies? ______
- Are you allergic to anything? If yes, do you require an epi-pen? ______
- Any medical conditions we should be aware about? ______
- It is expected of applicants to observe the ATR activities at least 2-3 shifts shadowing the current Sports Medicine Club students during April 2016. What dates/ days work best with your availability? Please list 6 dates during the month in the order of preference. We begin at 3pm. St. Lucy’s and PC students are given extra time to travel to our campus. School uniforms are the expected dress codes. No skirts, flip flops or sandals of any kind.
1. ______4. ______
2. ______5. ______
3. ______6. ______
Name: ______Grade: ______Date: ______
- Emergency Contact information
______
Mother’s Name (First and Last) Cell Phone Number Father’s Name (First and Last) Cell Phone Number
______
Additional Contact Person Name Cell phone Number Relationship to you
Part IV – Parent Permission
I have read the requirements of the club and give permission for my son/daughter to participate in the Damien High School Sports Medicine Club. I allow my son/daughter to travel with the athletics teams and athletic trainers to sporting events. If an emergency was to occur involving my son/daughter, I give permission for the sports medicine staff to provide evaluation and treatment of any injury.
______
Print Parent Name Parent Signature Date
Part V – Leadership Component
Please write a ¾ - 1 page essay (Double Spaced) that provides evidence of your leadership skills and why you feel you would be a great addition to our club. There are many ways to demonstrate leadership; in your family, informal groups like with your friends, and in daily life experiences. Leadership does not necessarily mean holding an office or position, and is not a requirement for membership. Also include how you can bring leadership to the Sports Medicine Club (NHSSM) or how you think this experience can help you gain leadership skills.
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