Ethics Complaint Form

Name of Athletic Trainer: *

Title: *

Employer: *

Phone No.: *

Address: *

City: *

State: *

Zip Code: *

1. Please identify the section of the NATA Code of Ethics that you feel has been violated.: *

2. Please provide a detailed factual scenario setting forth all relevant facts in support of your assertion of a violation or violations.: *

3. Please provide the name(s) and contact information (phone # preferred) of any and all witnesses to the alleged violation or violations.: *

4. Please provide a list of all documentation (and all copies of those documents) supporting your assertion of said violation or violations.: *

COMPLAINING INDIVIDUAL: *

Date: *