Dr. Champ Baker Jr, Young Professional Athletic Trainer Leadership Award
All completed applications must be submitted by 11:59pm on May 1st, 2020. This includes all supporting documentation. Please email resume to Awards@athletictraining.org.
Applicant's Name *
Applicant's Employer *
Applicant's Email Address
Applicant's Phone Number
Applicant's NATA/GATA Number *
Applicant's NPI Number *
Applicant's BOC Number *
Number of years as a certified athletic trainer: *
Personal Statement - Please tell the committee a little bit about yourself and your professional goals. *
What is and has been your involvement in the profession of athletic training (community, state, regional, national, etc)? *
If chosen as a recipient how do you intend to use the funds and the amount being requested (Conference at the state, regional, or national level; NATA Leadership Development course, etc.)? Please include a cost analysis of how the funds will be spent. *
By typing your name in the box below you acknowledge that you are aware that in order for your application to be considered two Recommendation Forms (https://goo.gl/forms/wt3eQqsCuG2HGBAR2, link also available on athletictraining.org) must be submitted. One must be from a fellow Certified Athletic Trainer and the other must come from the applicant’s place of employment (supervisor, AD, administrator, etc.; does not need to be a certified athletic trainer) *Neither of these people can be a family member* APPLICATION WILL BE CONSIDERED INCOMPLETE WITH OUT BOTH RECOMMENDATIONS. *
By typing your name below you acknowledge that you are aware that in order for your application to be considered a current resume must be submitted to the GATA Awards and Honors Committee at awards@athletictraing.org by the deadline. APPLICATION WILL BE CONSIDERED INCOMPLETE WITHOUT THIS. *
By typing your name below you formally submit your portion of the Dr. Champ Baker Young Professional Development Scholarship Application and attest that all the information provided is to the best of your knowledge accurate and true.
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