Arkansas Tech University
Athletic Training Questionnaire

Please answer all questions completely.

General Information

Your Name:       SSN:
Graduation Date:       High School:

Home Address:
City:       State:       Zip Code:
Home Phone:       E-mail address:

Number of Years Experience as a Student Athletic Trainer:
List Athletic Training Camps, workshops,class you have attended:
Sports worked as a Student Athletic Trainer:
Anticipated College Major:

Academic Information

School Counselor:
      Counselors Phone#:
G.P.A.       S.A.T.:       A.C.T.:

In a short paragraph, describe why you are interested in becoming a student athletic trainer at Arkansas Tech University :

How did you find our web page: Check all information before submitting this form.
Please SUBMIT this form only ONCE.