Rev. 2013

KLEIN FOREST HIGH SCHOOL

SPORTS MEDICINE

STUDENT ATHLETIC TRAINER APPLICATION

FOR THE STUDENT APPLICANT TO FILL OUT------PLEASE PRINT------

Name: ______Grade: ______Gender: M F

Date of Birth: ______Age: ______

Address: ______City: ______Zip: ______

Student’s Cell Phone #:______Student’s Email: ______

1. Parents Cell Phone #:______Parents Email:______

2. Parents Cell Phone #:______Parents Email:______

Home Phone #: ______Game Polo Shirt Size (adult):____ T-Shirt Size (adult) _____

In an effort to ensure the students accepted into the Sports Medicine Course/ Athletic Training Program will fulfill the personal/academic requirements, course work, coverage schedule and be a productive positive member of our team - please answer the following questions:

Ever received a D or F in any class? Yes No If “Yes” please explain: ______

Have you ever been given a referral, write up, ISS, ASD, suspension or any other disciplinary action? Yes No

If “Yes” – How many/Why/ Explain

______

Neatly write a brief summary including:

1) Why do you want to be a Student Trainer? 2) What you think a Student Athletic Trainer Does.

3) Describe your strengths and weaknesses. 4) How did you hear about the Forest Sports Medicine Program?

***YOU MUST ATTACH A COPY OF YOUR MOST RECENT REPORT CARD/ PROGRESS REPORT**

FOR THE STUDENT APPLICANT’S PARENT/GUARDIAN TO FILL OUT ------

1) Will transportation be a problem for early morning/late night events? YES NO

If “Yes” please explain: ______

2) Please fill out the following on a scale from 1 (lowest) to 3 (highest)

- Rate your son/daughters: Work ethic - 1 2 3

Responsibility level – 1 2 3

Commitment to projects started – 1 2 3

Respect of authority figures – 1 2 3

Ability to handle criticism – 1 2 3

Ability to get along with others - 1 2 3

Initiative 1 2 3

* IMPORTANT NOTES * - Your son/daughter if accepted will be required to follow a dress code.

- Your son/daughter if accepted will be required to maintain a minimum of a 70% or higher in all class.

- Your son/daughter if accepted will be required to work after school, holidays and weekends throughout the school year.

If there are any questions - please contact the Klein Forest Athletic Training Room at 832-484-4704.

Thank you for your interest, Randall T. Angerstein, LAT; Austin Matthews, LAT

______

Student Signature Date Parent Signature Date

RETURN THIS APPLICATION TO A KLEIN FOREST STAFF ATHLETIC TRAINER

BE ALL IN Or GET ALL OUT; There Is No Halfway!