Athletic Training Student Application
Name
*
First Name
Middle Name
Last Name
Date of Birth
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Education:
High School Attended
*
High School Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
GPA
*
Class Rank
xxx out of xxx (xxx/xxx)
SAT/ACT/TSI Scores
Graduation Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
List Extracurricular Activities, Honors & Awards:
Pervious Athletic Training Experience
*
Yes
No
How long?
Sports Covered
Supervising Athletic Trainer's Name
Email and/or Phone Number
Any Other Healthcare Experience?
References:
Name
Email and/or Phone Number
Name
Email and/or Phone Number
Personal Statement: Use the space below to tell us about yourself and why you would like to become an Athletic Training Student OR why you want to pursue a career in athletic training. (Between 200-300 words)
*
Submit
Should be Empty: