Athletic Training Application
This program does not meet the requirements for students seeking eligibility for the Board of Certification National Examination. The program adheres to Texas Law (451.153), enforced by the Texas Department of Health, that governs preparticipation for eligibility for Texas Licensure of Athletic Trainers.
I. Personal Information
First Name
Last Name
Middle Name
 
Home Address
City
State Zip
Home Phone
Cell Phone
Home Phone
Email
 (EXAMPLE: harris_guy@gmail.com)
Social Security Num
Date of Birth
(EXAMPLE: 12/08/1982)
Parent or Guardian Information
  
Last Name, First Name

Address
(if different from above)
City
State Zip
Relationship
 Parent Guardian
Home Phone
Work Phone

 

II. Education
Are you currently in school?
High School Name
School Address
City
State Zip
Graduation Date
(EXAMPLE: 05/2007)
School Phone
Grade Point Average
(EXAMPLE: 3.2)
College/University
Attended
Grade Point Average
(EXAMPLE: 3.2)
Work Experience in Athletic Training
*Prior Experience in athletic training is helpful but NOT a prerequisite.
Institution

Date

 (EXAMPLE: 11/2006)
Head Trainer
Do you plan on having a career in athletic training?
What will be / is your major?
Minor?
Are you a member of...
SWATA or NATA
In need of financial aid?
Are you proficient in taping?
Ankles Wrists Thumbs Fingers

 

III. Athletic Training Experience

Athletic Training Experience:
(Please include athletic training student experiences, highschool or college, sports worked, workshops/seminars, clinical experiences, etc.)

Do you plan to make Ath. Train. your primary work field?
If no, what field would you like to pursue?
What motivates you to be or participate with Athletic Training?
What do you think are the major job duties of an Athletic Trainer?
What do you feel is the relationship between an Athletic Trainer and other health care providers?

Describe your experiences that have prepared you to deal with 15 hours of classes and a minimum of 15-20 hours of clinical work experience each week?

 

IV. Activities/Honors

Extracuricular Activities: (Please include activities you participated in during high school or college such as, band, athletics, student council, etc

Academic Honors:

Church activities:

Work Experience:

 

 

V. References

Reference #1

Name
Address
City
State Zip
Phone
Email
 (EXAMPLE: harris_guy@gmail.com)
Reference Type:
Athletic Trainer Coach Physician Teacher Other

Reference #2

Name
Address
City
State Zip
Phone
Email
 (EXAMPLE: harris_guy@gmail.com)
Reference Type:
Athletic Trainer Coach Physician Teacher Other

Reference #3

Name
Address
City
State Zip
Phone
Email
 (EXAMPLE: harris_guy@gmail.com)
Reference Type:
Athletic Trainer Coach Physician Teacher Other