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Prospective Student Questionnaire

Please fill out the following form and click the Submit button. You may also print a copy for you records before submitting.*

 

Subject: *	I am a High School Student interested in your programI am a College Transfer Student interested in your programI would like further information about the NWU ATEP
Date: *
Name (Last, M.I., First): *
E-mail Address: *
Address: *
City: *
State: *	AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY -Terr.- AS FM GU MI PR VI
Zip: *
Home Phone: *
Cell Phone:
Previous School Attended: *
Anticipated Graduation/Transfer Date: *
GPA: *
Class Rank:
ACT Score:
SAT Score:
Career of Interest (Select all that apply): *	Certified Athletic Trainer Physical/Occupational Therapist Physician Assistant Physician Other
Any Clinical Experiences (PT Aide, Athletic Training Student, etc.): *	If none, type NONE
Did your High School have an Athletic Trainer?: *	Yes No
If so, who?:
What is your idea of what a Certified Athletic Trainer does?: *
Tell us a little about yourself. What makes you a great potential candidate for the NWU ATEP? *
Do you have any questions or comments about our program?
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