OHIO ATHLETIC TRAINERS’ ASSOCIATION
COLLEGE & UNIVERSITY SCHOLARSHIP APPLICATION FORM
* required

Name (Last, First):* ,

Email Address:*
Confirm Email:*

OATA membership # (6 digits)

Date Submitted (mm/dd/yyyy):*

Home Address:
Street:
City:
State Zip Code
Home Phone (xxx-xxx-xxxx):

ATEP Enrolled:
Year in ATEP/Length of P rogram (e.g., 1/ 3, 2/3, 1/4, etc.)

Anticipated Graduation date :*

Declared Major or Minor :

Academic Achievements:

GPA * (round to nearest 0.00; e.g., 3.88, 3.54, etc.)

Have you attended more than one college or university? Yes No
If YES, Please list:

Awards and Grants:
Please list awards (scholarships, grants, etc.) that you have received. These awards must have been earned while enrolled in college. Only include tangible awards that have been received (e.g., plaque, money, etc.). Dean's list, Honorary Societies, Greek Awards, certificates, or financial aid from college funding does not count.

Presentations:
Please list all presentations that you have given. Include the title, date, and location of the presentation. Presentations that have been given as a requirement of a college course do not count.

Publications:
Please list all publications that you have. A copy of the publication must accompany this application.

Clinical experiences:
Extra Even Coverage:
Please list any extra-events (e.g., athletic camps, club competitions, tournaments, etc.) for which you have volunteered. List only those events that are not a requirement for course credit.


Service Commitments:
Professional Meetings / Symposia:
Please list (with dates) all professional meetings and symposia related to Athletic Training that you have attended. A copy of the certificate of attendance, name badge, or letter of verfication from an ATC must accompany this application.

Professional Memberships:
Please list all professional organizations to which you are a member.


Professional Leadership :
Please list (with dates) any professional leadership positions and roles you have held while enrolled in an ATEP (e.g., club officer, OATA Senator, OATA Quiz Bowl, etc.)

Other Service :
Please list (with dates) all other community service activities in which you have engaged while enrolled in the ATEP (e.g., Race for the Cure, Project Open Hand, etc.)

Personal Statement (may type here or include an attachment for this after this entry ):
Briefly explain why you chose to enroll in college and what your post-baccalaureate career goals are. Also include a rationale for why you deserve and/or need this scholarship. Please limit your response to the space provided below.

Attachment of Candidate's personal statement :

List your 2 references: **
**Direct your references to the Scholarship Letters of Recommendation Link to supply these.

Type the text from this image:

Use alphanumeric digits only.