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WRIGHT STATE UNIVERSITY ATHLETIC TRAINING PROGRAM (ATP) APPLICATION

Date: ______(Please type or print in blue or black ink)

Name ______Last First Middle

Social Security Number ______Phone Number ( )______

Home Address ______Street City State Zip

Email Address ______

Names of Parents/Guardians ______

High School Attended/Graduation Date ______GPA ______

List special interests and hobbies:

______

PREVIOUS ATHLETIC TRAINING/STUDENT AIDE EXPERIENCES:

1. Athletic Training Workshops/Clinics:  YES  NO

Locations/Dates:______

______

2. Other experiences which have increased your athletic training knowledge/skills:

______

3. Sports you have worked with in high school or college:

______

______4. Name/phone number(s) of high school and/or college Head Athletic Trainer(s): ______

5. List significant high school activities you participated in:

______

6. List any awards received:

______

7. Intended major field of study in college:

______

8. Type of work desired after college (if known):

______

UNDERGRADUATE APPLICANTS - Please complete the following information:

Current major/minor: ______

Current GPA: ______

Please check the following courses, which you have completed:

 Basic Principles of Athletic Training  Athletic Emergency Care  Assessment of Athletic Injuries  Personal Health  Advanced Athletic Training  Anatomy & Physiology  Therapeutic Exercise in Athletic Training  Nutrition  Therapeutic Modalities in Athletic Training  Exercise Physiology  Organization & Administration of AT Prgms  Biomechanics/Kinesiology Other (please describe):

TRANSFER STUDENTS - Please complete the following information:

______College/University Degree Earned Dates GPA ______College/University Degree Earned Dates GPA

ALL APPLICANTS:

List the name and phone numbers of three persons from whom you have requested recommendations. Please have these people forward the recommendation forms on or before the February 1st deadline (fall admission) or July 1st (spring admission).

______Name Phone Number

Please return this application form and all other materials postmarked by June 1st to:

Rebekah Bower, MS, AT, ATC Program Director, AT Program Wright State Physicians Bldg. 725 University Blvd. Dayton, OH 45435-0001