Barton Online Forms

STUDENT ATHLETIC TRAINER QUESTIONNAIRE

Personal Information:

Social Security #:	Last Name:
First Name:	Middle Name:
Name you prefer to be called:
Street Address:	City:
State:	Zip:
Date of Birth:	Home Telephone #:
E-mail:	Cell Phone #:
Father's Name:	Mother's Name:
Father's Occupation:
Mother's Occupation:

Educational Information:

High School Name:

City:

State:

Zip:

High School Telephone:

Date of Graduation:

Current Grade Point Average:

ACT Score:

SAT Score:

Honors, Extra- Curricular Activities, etc.

College/ University Attended (W/ Years)

Intended College Major:

Athletic Training Experience:

What sport(s) (with head coach's game & grade) have you participated in as a student athletic trainer/ manager?

What athletic training workshops/ clinics (w/dates) you have attended?

What sport(s) (w/grade) have you participated in as an athlete?

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