www.OATA.org | Officer Candidate Biography Form

This form is only to be used by those individuals who desire to be in an Officer Position.

OHIO ATHLETIC TRAINERS’ ASSOCIATION
OFFICER CANDIDATE BIOGRAPHY
(Ballot Biographies will be produced from this information )

Name (Last, First): ,
Office Applied:

Email Address:
Confirm Email:

BOC certification # (9 digits)
Ohio License # (ex. AT-XXXXXX)

Date Submitted (mm/dd/yyyy):

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

Primary Place of Employment
Schools covered (if necessary):

Office address:
Street:
City:
State Zip Code

Office phone (xxx-xxx-xxxx):
Office fax (xxx-xxx-xxxx):

Years in Profession :
Years in O.A.T.A.:

1. Education :
College : Degree:
College : Degree:
College : Degree:

Chronological Order:
2. Specialized Training / Qualification :

3. Athletic Training Employment History :
A. Name and Places :

B. Volunteer, special games or contests worked as an athletic trainer :

4. Awards, Lectures, Publications, other endeavors critical to athletic training :

5. Offices held or committee appointments at local, state, district or national level:

6. Summary statement for this O.A.T.A. office (cut & paste):

Type the text from this image:
Captcha Image: you will need to recognize the text in it.
Use alphanumeric digits only.

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	This form is only to be used by those individuals who desire to be in an Officer Position. OHIO ATHLETIC TRAINERS’ ASSOCIATION OFFICER CANDIDATE BIOGRAPHY (Ballot Biographies will be produced from this information ) Name (Last, First): , Office Applied: Email Address: Confirm Email: BOC certification # (9 digits) Ohio License # (ex. AT-XXXXXX) Date Submitted (mm/dd/yyyy): Home Address: Street: City: State Zip Code Home Phone (xxx-xxx-xxxx): Primary Place of Employment Schools covered (if necessary): Office address: Street: City: State Zip Code Office phone (xxx-xxx-xxxx): Office fax (xxx-xxx-xxxx): Years in Profession : Years in O.A.T.A.: 1. Education : College : Degree: College : Degree: College : Degree: Chronological Order: 2. Specialized Training / Qualification : 3. Athletic Training Employment History : A. Name and Places : B. Volunteer, special games or contests worked as an athletic trainer : 4. Awards, Lectures, Publications, other endeavors critical to athletic training : 5. Offices held or committee appointments at local, state, district or national level: 6. Summary statement for this O.A.T.A. office (cut & paste): Type the text from this image: Use alphanumeric digits only.

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	The Ohio Athletic Trainers' Association www.OATA.org
	The Ohio Athletic Trainers' Association www.OATA.org

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