Scholarship test page – MAATA – Mid-America Athletic Trainers' Association

BIOGRAPHICAL INFORMATION

Scholarship Applying For *

First Name *

Middle Name

Last Name *

Local Address *

City *

State *

Zip Code *

Home Address *

City *

State *

Zip Code *

School Phone *

Home Phone *

Email Address *

Date of Birth *

PROFESSIONAL EDUCATIONAL INFORMATION

Current College/University *

Undergraduate College/University *

Major(s) *

Minor(s)

GPA in Major *

Overall GPA *

Grade Point Scale *

4.0

5.0

What is your academic year in your accredited program? *

How many semesters have you completed in your master's program? (Summer counts as 1 semester) *

Have you won a previous MAATA Scholarship Award in the Professional Undergraduate category? *

Have you won a previous MAATA Scholarship Award in the Professional Graduate category? *

Have you been accepted to a Post-Graduate School *

Yes

Current Post-Graduate University *

Date of Application Submission *

Are you a member of the NATA? *

Year membership began? *

Enter your NATA member number: *

NPI Number

Are you a member of District V?

What is your current position? *

Are you currently serving as a graduate assistant athletic trainer? *

Yes

Name of nominating Athletic Trainer *

Nominating athletic trainer may not be oneself

Nominating Athletic Trainer Years of Experience *

Are you currently planning to make athletic training your primary field of professional endeavor after graduation? *

Yes

If no, what occupation do you plan to enter? *

BIOGRAPHICAL SKETCH

Who were the key individuals and what were the important factors that influenced your decision to enter the field of athletic training. *

How have you participated in athletic training since your interest in the field began? Include sports, teams, or areas where you have been involved in the practice of athletic training. *

List any athletic training experiences/volunteer athletic training experiences outside of assigned clinical rotations: *

List any honors or awards you have received, research conducted (outside of class assignments), presentations you have done at your current College/University. *

Describe any participation in athletic training related organizations, clubs, activities (including research), memberships related to your athletic training program or the athletic training profession. *

Describe any participation in community organizations or associations unrelated to athletic training. Also, describe any previous employment experiences which have helped you supplement your education. *

What are your short term (1-2 years) and long term (5 to 10 years) professional goals ? *

Resume *

Maximum file size: 10MB

Please upload a one page copy of your resume (preferably in PDF or DOC/DOCX form)

Unofficial Transcript *

Maximum file size: 10MB

Please upload an unofficial copy of your transcript (PDF format only)

SIGNATURE

Full Signature Name *

Signature *

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