OHIO ATHLETIC TRAINERS’ ASSOCIATION
STUDENT LEADERSHIP AWARD NOMINATION

Nominee's Name (Last, First): ,

Nominee's Email Address:
Confirm Email:

NATA member # (6 digits)

Date Submitted (mm/dd/yyyy):

Nominee's Permanent Address:
Street:
City:
State Zip Code
Phone (xxx-xxx-xxxx):

College/University:
Major:
Year in school: Choose One: Freshman Sophomore Junior Senior

School Information:
Program Director :
Program Director phone (xxx-xxx-xxxx):
Program Director email:

Supervising ATC (if different) :
Supervising ATC Phone :
Supervising ATC email :
Last OATA/GLATA Meeting Attended :
Leadership Positions Held :


Nominator Last: First:
Address:
City: State: Zip: (Zip+4)
Phone: Email:
Job Title:

Narrative of why this student should win the student leadership award (cut & paste):

Attachment of Narrative:
Attachment of Resume:

Type the text from this image:

Use alphanumeric digits only.