S
OUTHWESTERN
U
NIVERSITY'S
A
THLETIC
T
RAINING
P
ROGRAM
Athletic Training Prospective Student Information Form
Please complete the following form so one of our staff can contact you with further information about the Athletic Training Program.
PERSONAL INFORMATION
First Name:
Middle Initial:
Last Name:
Mailing Address:
Mailing Address 2:
City:
State:
Zip Code:
Country (if outside US):
Telephone:
FAX number:
E-mail:
HIGH SCHOOL BACKGROUND
High School:
Date of Graduation:
City:
State:
Coach:
Office Phone:
Athletic Trainer:
Office Phone:
ACADEMIC BACKGROUND
Years of the following subjects:
Math:
English:
Science:
Class rank is:
out of a class of:
Grade point average:
on a
GPA scale.
Composite test scores:
ACT:
SAT:
ATHLETIC TRAINING BACKGROUND
Years in Athletics Training:
Sports worked
Current certification (check all that apply):
First Aid
CPR
EMT
Other
Workshops/Clinics attended
Other related experience
How did you hear about our program?
Other honors and awards
Other interests
Any questions or comments?