NATA CUATC Assistant Athletic Trainer Award Nomination Form

Criteria: (must meet all 5 for eligibility)

Must be BOC-certified, employed full-time and currently employed in a collegiate setting.
Minimum of 75% of current employment responsibility involved primary/direct coverage and care of collegiate athletes.
Minimum of 7 years college experience (Does not include undergraduate experience or graduate assistantship. Employment for college experience does not have to be continuous at same institution).
Must currently be employed with the position/title of Assistant Athletic Trainer (or similar).
Actively involved in: local community/campus volunteer service, national/district or state athletic training associations, and promotion of athletic training and exceptional athletic training performance (single or multiple acts that may distinguish the athletic trainer).

Completed Nomination Forms should be submitted online by December 1.

Name:

Last: *

First: *

Middle: *

Credentials: *

Address:

Home

Street Address: *

City: *

State: *

Zip: *

Work Phone: *

Home Phone: *

Fax:

Email: *

Primary Occupation: *

Current Activities at the State, District or National Level: *

Current Activities Within Local Community/Campus Involvement or Volunteer Service: *

Other Current or Notable Activities: *

Nominator’s Statement of Support for Candidate: *

Nominated by:

Nominator Last: *

Nominator First: *

Date (MM/DD/YYYY): *

Work

Nominator Work Street Address: *

Nominator City: *

Nominator State: *

Nominator Zip: *

Nominator Work Phone: *

Nominator Email: *