Elder Rehab with Dr. Sharon Arkin
Elder
Rehab is a research-tested physical, mental, and social stimulation program,
developed by psychologist, Sharon Arkin. A senior, memory-impaired participant
will be partnered with a U of A volunteer “Personal Trainer” who will supervise
the participant in physical fitness workouts and engage in memory and language
stimulation.
Both
participants and family members leave having a better mood and clearer mind.
This program allows memory impaired elders the chance to interact with young, vibrant
college students while improving their physical and mental capabilities.
Dr. Sharon Arkin
520-603-2912
arkinaz@earthlink.net
Tucson
Jewish Community Center
Elder
Rehab Student Application Form
Date
Submitted Date/Time
Received
Name________________________Available Fall 2017?___ Spring 2018?_____________
Specify time periods when you are available.
2 hour time periods available on:
Tues. between 10- 6:_______ Thurs. between 10-6:_______
Mon. between 2-6_______ Wed. between 2-6_______
Fri. between 2-6_______ Sun. between 10-6_______
Email
Phone Number _________Current
CPR?____- (required before
beginning internship or volunteering)
Current
Semester (as of fall ’17): (1sts, 2nd, etc.)
Major
Career
Goal
Grad
School?
Local
Address Zip
Code
Living
arrangement (alone, w/ roommate(s), etc.)
Parents’
Names:
Parents’
(Your permanent) address
Parents’
Phone Number: Email:
Do
you have a car or access to a car? License? Car Insurance?
Can you get
parents’ OK to drive another student or your senior partner in your car?
Describe any
experience working out on gym equipment, such as treadmill, stationary bike,
weight machines or other physical activities (i.e., yoga, dance, sports, etc.).
Name______________
Do you have a pet
or is there some other interest, craft, or musical activity that you could lead
?
Describe.
Describe any previous volunteer
experience:
Previous
work experience:
Do you have a
family member or friend who had or has Alzheimer’s or a similar disorder
involving memory loss and communication difficulties?
If yes, Describe
Reasons for wanting to be an Elder
Rehab volunteer or intern
Questions? Call Dr.Arkin 520-603-2912