Athletic Therapy Travel Request Form
Use this form if you would like to request a student Athletic Therapist to travel with your team. Please note that we cannot guarantee we will be able to meet your request but we will do our best.

Please also note that we require at least 1 week notice to request an AT to travel with your team.
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Email *
Requesting Coach Name *
Email address *
Travelling Team(s) *
Game Location *
Approximate # of Athletes *
Date of Travel *
MM
/
DD
/
YYYY
Time of Game *
Time
:
Anticipated Departure Time *
Time
:
Method of Transportation *
Supplies
Please note that the student Athletic Therapist will be carrying a medical supplies kit when they travel. If your team requires any specific supplies, please list them below.
Additional/Specific Supplies Request
Additional Information
Please list any additional information pertinent to travel or your athletes (current injuries, etc.)
Additional Information
A copy of your responses will be emailed to the address you provided.
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