RMATA Scholarship - Nominating ATC

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To be completed by the nominating ATC for scholarship application.

PART A: Nominating ATC and Candidate Information

First Name of Nominating ATC *

Last Name of Nominating ATC *

BOC Certification of Number Nominating ATC *

NATA Number of Nominating ATC (If applicable)

Email Address of Nominating ATC *

Phone Number of Nominating ATC *

Place of Employment of Nominating ATC *

Candidate's First Name *

Candidate's Last Name *

Candidate's BOC Certification Number (If applicable)

Candidate's NATA Number (If applicable)

Candidate's College/University *

PART B: Nominating ATC Recommendation

Please rank this candidate in relation to other students in the same category

EXCELLENT

GOOD

AVERAGE

FAIR

POOR

Intellectual Ability

Writing Ability

Speaking Ability

Leadership Ability

Academic Preparation

Clinical Aptitude

Interpersonal Skills

Willingness to Learn

Maturity

Initiative

Responsibility

Dependability

Loyalty

Promptness

Attention to Detail

Honesty and Integrity

Motivation

Clear selection

PART C: Letter of Recommendation

If you would prefer to submit a Letter of Recommendation by email, please send to the following address with the candidate's name in the Subject Line. scholarship@rmata.org

Will you be emailing a Letter of Recommendation? *

Yes

No - Please type you letter below.

Letter of Recommendation

PART D: Verification

I hereby confirm that all information is true and correct. *

YES

Submit

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