District 3- Mid-Atlantic Athletic Trainers’ Association

Student Senate

State Representative Application

Name:
Institution:
(*denote if Entry Level Masters’ program)
Year in School: / Anticipated Grad Date:
Current (School) Address:
Permanent Address:
Home Phone:
School Phone:
Cell Phone:
Email Address:

Are you a National Athletic Trainers’ Association Member? Yes____No_____

If yes, for which state?Member Number:

Date of initial membership:

(Membership in the NATA is required, preferably within the MAATA)

References / In addition to your Program Director, please list one other professional reference that we may contact
Program Director:
Name:
Email address:
Phone:
Reference #2:
Name:
Title:
Email address:
Phone:

If you have previously attended any professional meetings / conferences, please list those below:

Conference:

Date:Location:

Conference:

Date:Location:

Conference:

Date:Location:

Please list and describe any leadership experiences that you have had or positions that you have held. Please list the organization, position held and dates. If additional space is needed, attach a separate sheet.

In addition to this information you have provided please submit the following:

Completed application

Statement (limit 300 words) indicating why you are interested in the MAATA Student Senate and what positive influence you feel that you can bring to the delegation

Letter of Recommendation from ATEP Director or AT Club Faculty Advisor

Please submit all materials electronically to Andi Bender at . Letters of recommendation should also be submitted electronically and submitted directly by the recommender from a campus email account. (Please notify me if this is not possible). Please submit the letters of recommendation in a Microsoft Word file. Place “MAATA Student Senator Application” in the subject line. We encourage applicants to introduce themselves to the senators and advisors if attending the symposium. Voting will occur at the conclusion of the symposium and applicants will be contacted individually via phone or email the following week.

Application materials must be received by5pm onWednesday, May 7, 2014.

Send materials to:

Andi Bender, MS, LAT, ATC

University of North Carolina Wilmington

Athletic Training Education Program

601 S. College Rd.
Wilmington, NC 28403

910-962-7537

Questions can be directed to:

Andi Bender at or 910-962-7537 office; 919-667-3804 cell

Alyssa Fisher at or (717) 817-2510