OHIO ATHLETIC TRAINERS’ ASSOCIATION
STUDENT LEADERSHIP AWARD
CANDIDATE BIOGRAPHY SHEET
(Award Biographies will be produced from this information )

Name (Last, First): ,

Email Address:
Confirm Email:

Date Submitted (mm/dd/yyyy):

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

NATA Membership number (6 digits)

College/University: GPA: (X.XX)

Conferences/Meetings attended in the past year :

Other Awards received within the past year :

Presentations or Publications during the past year :

List the Clinical Experiences during the past year (include the number of hours completed and any EXTRA event coverage you have completed) :

List ALL leadership positions at the College/University during the past year(includes membership on quiz bowl teams and leadership positions inside and outside of athletic training) :

Community Service done during the past year :

Provide a narrative that describes you as a leader (or include an attachment instead) :

Attachment of Nominee's Narrative:
List Name & Title of person writing a letter of recommendation :

Type the text from this image:

Use alphanumeric digits only.