For OFFicE UsE Instructor Training Workshop Application Form

appendix OneFOR OFFICE USEDATE OF TRAININGarthritis foundationInstructor Training Workshop Application FormCOMPLETE ALL SECTIONS. TYPE OR PRINT NEATLY.This application is for:Initial TrainingLOCATIONToday’s Date: / /RecertificationCONTACT INFORMATIONFIRST NAME:MI:LAST NAME:JOB TITLE:ORGANIZATION:WORK ADDRESS:CITY:STATE:ZIP:STATE:ZIP:HOME ADDRESS:CITY:HOME PHONE:WORK PHONE:CELL PHONE:EMAIL:FOR ARTHRITIS FOUNDATION CORRESPONDENCE, PLEASE CONTACT ME AT:MY WORKSITE (IF APPLICABLE)MY HOMEFACILITY INFORMATION Please provide information about the host facility where you plan to teach theArthritis Foundation Exercise Program classes (if different from your job location):FACILITY NAME:ADDRESS:CITY:STATE:ZIP:ADMINISTRATOR/ CONTACT PERSON NAME:PHONE NUMBEREMAIL ADDRESS:Does the location where you plan to teach havea signed Program Co-sponsorship Agreement with the AF? YES NOQUALIFICATIONS *Attach copy of cardDO YOU HAVE CURRENT ADULT CPR CERTIFICATION? (REQUIRED)DO YOU HAVE CURRENT FIRST AID CERTIFICATION (RECOMMENDED)YES* YES* NONOLIST OTHER RELEVANT CERTIFICATIONS AND THEIR EXPIRATION DATE:57continued on back

Instructor Training Workshop Application Form continuedEXPERIENCEWhat professional or volunteer experience have you had leading exercise classes, conducting workshops orspeaking in public?What is your profession and/or background in health, fitness or education? List any relevant degrees or coursework.What other experience do you have that you feel would be beneficial in leading AF programs (such as work withpeople with disabilities, older adults, people with special needs)?What is your experience with arthritis (personal or family member diagnosis, or work with people with arthritis)?Why do you want to teach the Arthritis Foundation Exercise Program? What benefits would you like to gain fromleading this program?How did you become aware of the Arthritis Foundation Exercise Program?Have you been a participant in any Arthritis Foundation programs and if so, what?FEE INFORMATIONPlease chargeto myAMEX XX for Initial CertificationVISA XX for RecertificationPlease send complete application,payment and attached SIGNED Statementof Understanding to:MCCard #:Expires:Name on Card:Signature:Please make checks payable to:58

appendix Onearthritis foundationLeader/Instructor Statement of UnderstandingThe Arthritis Foundation has established the following policies and procedures toensure the quality of its programs. Please sign on the following page to indicateyour acknowledgement and acceptance of these requirements: As the first step in becoming an AF certified Leader or Instructor, I will attend and successfullycomplete an AF Leader/ Instructor Training Workshop conducted by trainers who are nationallycertified and authorized by the Arthritis Foundation. I will actively participate in all aspectsof the training. I understand that only approved trainers can teach others to become AFLeaders or Instructors. I may not teach others how to lead the AF program classes. In order to attend an AF Leader/ Instructor Training Workshop, I will pre-register by submitting a completedApplication Form and this signed Statement of Understanding. I will be pre-screened by the AF to ensurethat I have the appropriate prerequisite qualifications. I will receive written confirmation of my attendanceat the workshop. I understand that walk-ins are not allowed at AF Leader/ Instructor Training Workshops. As the second step in becoming an AF certified Leader or Instructor, I will conduct an Arthritis FoundationSelf-Help Program course series of at least 6 weeks duration or at least six one-hour class sessions ofthe Arthritis Foundation Aquatic Program or Arthritis Foundation Exercise Programwithin six months of completing the AF Leader/ Instructor Training Workshop. As a condition of maintaining my certification, I will further conduct a minimum of oneArthritis Foundation Self-Help course series or six Arthritis Foundation Aquatic or ArthritisFoundation Exercise class sessions each year. I will send the attendance lists from these classesto the AF. I will also attend an AF Recertification Workshop every three years and agree toparticipate in annual continuing education activities when available from the AF. I understand that certification as an AF Leader or Instructor provides me with a limited license todeliver the AF program in which I’ve been trained as long as I maintain my affiliationwith the Arthritis Foundation and uphold its policies and procedures. I acknowledge that theAF program materials are copyrighted and agree to honor the programs’ copyright protection. I will offer AF classes only at sites that have a complete and current Program Co-sponsorship Agreementon file with the AF documenting their compliance with AF policies and their acceptability as host sites,including adequate insurance coverage and accessibility to people with disabilities. I agree to notifythe AF if I stop teaching the AF program at the approved site or if my teaching status changes. I will conduct and support marketing efforts for the AF classes in my communityin collaboration with the AF. I will notify the AF well in advance of each courseseries to assure adequate time for promotion and other preparations. I will stress my collaboration with the AF in all marketing materials and during every AF course series.I will assure that participants recognize the AF’s co-sponsorship of the programs.I will provide participants with information about other AF programs and services.59continued on back

arthritis foundation Leader/Instructor Statement of Understanding I agree to follow the standardized program curriculum and will not make anyvariations in the approved program content or process described in the programleader/instructor manuals without prior written permission. To protect the AF and the host facility against legal claims, I will secure Participant Release Formsfrom all new course participants and will submit these forms to the AF. I will also communicateand enforce the safety principles I learn in the AF Leader/ Instructor Training Workshop. I will submit complete and timely participant data and participate in any other data collectionprojects that the Arthritis Foundation uses to measure the reach, quality and/or impact ofthe AF programs in accordance with a specified reporting schedule and method. I agree to uphold and maintain the policies, procedures and standards of the AF programand to fulfill all obligations listed in the AF Leader/ Instructor Position Description andin the AF Leader/ Instructor manuals and guidelines and procedures manuals. I understand that the Arthritis Foundation is a voluntary health organization. Ifserving in a voluntary capacity, I will not receive compensation or employee benefitsfrom the Arthritis Foundation. However, an honorarium may be paid.This agreement applies to:Arthritis Foundation Aquatic ProgramArthritis Foundation Aquatic Program for JAArthritis Foundation Exercise ProgramArthritis Foundation Self-Help ProgramI HAVE READ AND I UNDERSTAND THE PRECEDING STATEMENTS. I FURTHER UNDERSTAND THATCOMPLIANCE WITH THIS STATEMENT OF UNDERSTANDING IS REQUIRED FOR MY TRAINING ANDCONTINUED PARTICIPATION AS AN ARTHRITIS FOUNDATION LEADER OR INSTRUCTOR.print name of leader/instructor applicant datesignature60

appendix twoarthritis foundationInstructor Training Workshop Sample Agenda8:00 – 8:15Registration10:20 – 10:35Exercise assignments and BREAK8:15 – 8:45Session One:10:35 – 12:00Program exercises:Welcome And Overviewdemonstration and practice Welcome and introductions Training workshop overview12:00-12:45 Introduction to the Arthritis12:45 – 1:55Foundation Overview of the Arthritis FoundationExercise ProgramLunchExercise demonstrations continued Balance component1:55 – 2:55Session Five: Endurance Overview of endurance activities8:45 – 9:15Session Two: Medical Aspects of Arthritis Review of basic concepts of arthritis Regulating and monitoring intensity Demonstration and practice Review of treatments for arthritis Practical application to class2:55 – 3:10Break3:10 – 3:30Session Six: Relaxation9:15 – 9:20Soft break Overview9:20 – 9:50Session Three: Health Education Demonstrationand Teaching Tips Health Education overviewand how-to’s Welcome and closing activities Teaching tips9:50 – 10:203:30 – 4:15 Program progression Integrating new participants intoongoing classes Lesson planning practiceSession Four: Exercises Overview of program exercises Joint Check warm-up and cool-downSession Seven: Lesson Planning4:15 – 5:00Session Eight: Logistics Program policies and logistics Questions and answers Evaluation and closing activities61

appendix threearthritis foundationLesson Planning Practice WorksheetDirections Your trainer will assign your group one of the Class Types listed below. Work with your group to develop a one-hour lesson plan that meets the needs of the typeof participants assigned to you. Include all of the essential program components and at least one exercise for each majorbody area. Use the blank lesson plan on the back of this sheet to record your selected exercises andother activities. Be sure to include the amount of time you will spend on each section. You have 15 minutes to complete this exercise.CLASS TYPES1.Your class meets in a senior center. The participants are mostly elderly with severe jointproblems and balance issues. PLAN A CLASS FOR WEEK 1.2.Your class meets after work in an office fitness facility. The participants are younger,more active people who have fibromyalgia and beginning osteoarthritis. PLAN A CLASSFOR WEEK 4.3.Your class meets in the hospital education department. Some of the participants areolder and have osteoarthritis; others have severe rheumatoid arthritis with significantjoint damage. PLAN A CLASS FOR WEEK 8.4.Your class meets in a community fitness center. The participants have mixed levels ofability and fitness – some are elderly with severe joint problems and balance issues;some have fibromyalgia and beginning osteoarthritis but are still fairly active andworking; some are middle-aged with severe rheumatoid arthritis and significant jointdamage. They range in age from the early 30s to the 80s. PLAN A CLASS FOR WEEK 6.63

l e s s o n p l a n n i n g p r ac t i c e w o r k s h eet c o n t i n u e dWeek , SessionProgram ComponentBeginning ClassAdvancedParticipantsor Ongoing ClassWelcome – minutesHealth Education – minJoint Check Warm-up – minExercise – min1. ROM and StrengtheningExercises2. Balance exercises3. Endurance routineJoint Check Cool-down –minRelaxation – minClosing – min64

appendix fourarthritis foundationExercise Program InstructorTraining Workshop Evaluation FormCheck the appropriate boxes:To what extent areyou able to:1234512345CompletelyReasonablywellPartiallyVery littleNot at allIdentify the program’sessential components.Explain how the programaddresses the special needsof people with arthritis.Describe how to conductJoint Check activities withbody awareness cues.Describe exercise precautionsfor participants with arthritis.Identify safety principlesfor the use of resistancebands and weights.Demonstrate the ability todevelop a lesson plan thataccommodates mixed level classes.Describe AF data collectionrequirements.How confident are you inyour ability to:CompletelyReasonablywellPartiallyVery littleNot at allLead the health education lessons.Demonstrate the approvedprogram exercises, JointCheck, balance and enduranceactivities correctly.Demonstrate the correct use ofresistance bands and weights.Lead a class with participantswith mixed levels of capability.Lead relaxation techniques.65continued on back