08/13/2008 08:02 AM
Last Name
First Name
Middle Name
Date
School Address
City
State	State AL FL GA KY LA MS TN
Zip Code
School Phone
Email
Home Phone
Date of Birth
Age
Place of Birth
Father's Name
Mother's Name
Father's Occupation
Mother's Occupation
Marital Status	MaritalStatus Single Married Divorced Widowed Separated
Spouse's Name
Number of Dependent's
Name of High School
High School City
High School State
Undergraduate College or University
Undergraduate Major
Undergraduate Minors
Cumulative Grade Point Average (at time of application)
Grade Point Scale	Grade Point Scale 4.0 5.0
Additional Education special training i.e. EMT, CPR, First Aid
Are you a current member of the NATA?	NATA Membership? Yes No
NATA Membership Number
How many years?
Are you a current member of the Southeast Athletic Trainers' Association?	SEATA Membership? Yes No
How many years?
Are you a currently an athletic training student?	Currently an Athletic Training Student? Yes No
Name of your supervising athletic trainer
High School
College/University
What sports have you had experience with?
Are you currently planning to make athletic training your primary field of professional endeavor after graduation?
If not, what occupation do you plan to enter?
In the space provided, please give a brief biographical sketch of yourself.  You should include the following:  your reasons for wanting the Scholarship, why you merit this award, awards won in high school and college (if any), organizations to which you belong or have belonged (i.e. religious, service, social, etc.). athletic teams you have worked with and jobs you have held (during the summers or while attending college).