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Medical Exercise Specialist

Pre-Approval Form

To take the Medical Exercise Specialist Certification Exam, you must have a minimum of 500 hours of work experience designing and
implementing exercise programs for apparently healthy individuals and/or high risk, individuals, as documented by a qualified professional.

Medical Exercise Specialist candidates must submit the following documentation for approval:
1. Pre-Approval Form completed by a qualified professional – Please see below.

2. Copy of diploma or unofficial transcripts verifying proof of a completed Bachelor’s degree or higher in exercise science or related field.

TO THE APPLICANT: This form must be filled out by a QUALIFIED PROFESSIONAL only (i.e. allied health professionals, fitness directors, club
managers, professors or teachers)

 Please provide your professional information in the box below.
 In the space provided (or attach separate a document), please comment on the candidate’s 500 hours (or more) of work experience related
specifically to his/her knowledge and skills in:

1. Risk Factor Screening

2. Client Interview and Client Assessment
3. Program Design, Implementation and Modification

Candidate Name: Evaluator Name: Georgia Frey

Organization: Indiana University Title: Associate Professor
Address: 1025 E. 7th St./SPH 112
City: Bloomington State: IN Country: USA Zip code: 47405
Day Phone: 812-855-1262 Email:
Licenses/Certifications Held:
Degrees Held: Ph.D.

I was Mr. Hill’s supervisor while he served as a physical activity/fitness (PAF) specialist for the College Internship Program (CIP), an agency that
supports about 20 young adults with autism spectrum disorders. Based on my supervision of his work with the CIP program, I am confident that he
meets the eligibility requirements to take the ACE Medical Exercise Specialist Certification Exam.
His specific responsibilities included, but were not limited to, PAF pre-testing, general health assessment, developing individualized PAF programs,
delivering programming in both group and individual settings, PAF coaching, helping clients identify community-based activities, adapting activities to
individual needs, charting progress and entering data into the CIP database, teaching clients how to engage in healthy lifestyles, teaching clients safe
fitness equipment use and proper technique, working collaboratively with the CIP staff to help clients meet other goals, and PAF post-testing. He also
participated in other aspects of CIP programming, such as reinforcing social skill and behavior goals for the clients. His time commitment to this work
was 20 hours per week for three 16 week semesters, which equals over 900 hours.

Through this experience, Mr. Hill gained valuable knowledge, skills and abilities working with individuals with multiple challenges, including delays in
communication, social skills, and behavior as well as mental health conditions. He developed a strong rapport with his clients, earned their trust and, as
a result, was adept at motivating them to consistently participate, which can often be very difficult in this population segment. He excelled at modifying
activities for clients with chronic illnesses including diabetes, obesity, and asthma. People with autism spectrum disorders commonly have motor skill
delays that make it difficult for them to perform standard movements. Mr. Hill was adept at identifying these delays and adapting the activity to maximize
successful participation. I was also impressed that he implemented diverse programming by exposing students to a variety of strength, flexibility and
cardiorespiratory promoting activities such as obstacle training, yoga, and tai chi. In summary, through Mr. Hill’s work providing quality PAF
programming to young adults with autism spectrum disorders, he has met the ACE Medical Exercise Specialist Certification Exam time and experience
eligibility criteria.

I attest that the above named applicant, to the best of my knowledge, has at least 500 hours of experience designing and implementing exercise and physical activity
programs for apparently healthy individuals and/or those with health challenges who have been cleared by their physician. I understand that I will not be held responsible
for any actions from the applicant arising from the application process for the ACE certification exam, nor from the applicant’s work as an ACE-certified Professional.
Digitally signed by Georgia Frey
Georgia Frey Date: 2018.06.22 10:21:20 -04'00' DATE: 6/22/2018

Please return this completed form to:

ACE EXAM REGISTRATION 4851 Paramount Dr. San Diego, CA 92123
FAX 858-576-6564 800-825-3636 EXT 783