NATA CUATC New Horizon Award Nomination Form

Criteria: (must meet all 6 for eligibility)

Must be BOC-certified.
Minimum of 3 years college experience (Does not undergraduate experience or graduate assistantship. Employment for college experience does not have to be continuous at same institution).
Minimum of 75% of current employment responsibility involved primary/direct coverage and care of collegiate athletes.
Employed as an athletic trainer in the collegiate setting as the head or assistant athletic trainer.
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).
Demonstrates the attributes of a future leader in the athletic training profession.

Completed Nomination Forms should submitted online by December 1.

Name:

Last: *

First:

Middle: *

Credentials: *

Address:

Home Street Address: *

Home City: *

Home State: *

Home Zip: *

Work Street Address: *

Work City: *

Work State: *

Work Zip: *

Work Phone: *

Home Phone: *

Fax:

Email: *

Primary Occupation: *

Current Activities and/or Exceptional Performance

Please List and Describe Current Activities and/or Exceptional Performance of the Nominee: *

Nominator’s Statement of Support for Candidate: *

Nominated by:

Nominator Last: *

Nominator First: *

Date (MM/DD/YYYY): *

Nominator Work Street Address: *

Nominator City: *

Nominator State: *

Nominator Zip: *

Nominator Work Phone: *

Nominator Email: *