Personal Information:

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