!"#$"%&'()*+'
,"-.'*'/0'1
'
!"#$%&'(!)##"*$+*,$(-$&$"(.#+/"%0+$1(
2"3&%$4"#$()5(6710+*&'(89,*&$+)#(:(;,4&#(6"%5)%4&#*"(
<33'+*&$+)#(5)%(<94+00+)#(+#$)($7"(<$7'"$+*(=%&+#+#>(89,*&$+)#(6%)>%&4'
2"&9'+#"0(5)%(-,?4+00+)#(
@&''(-"4"0$"%A(-"3$"4?"%(BC
$7
((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((-3%+#>(-"4"0$"%A(@"?%,&%1(BC$7(
'
<2DE--EFG(=F(=;8(<=;H8=E!(=I<EGEGJ(82.!<=EFG(6IF@8--EFG<H(6IFJI<D'
2#3.%-%"3$"4.'"55678"#49'9..:7#-'"3;7997/#'4/'4<.'"4<6.478'4%"7#7#-'.3$8"47/#'5%/-%"; '"%.'%.=$ 7%.3'4/ '9$>; 74'"'076.'/0'; "4. %7"69'
0/%'%.?7.@'>&'4<. 'A. 5 "%4; . # 4'/0',< &978 "6'B3 $ 8"47/ #'"#3 'C$;"#',.%0/%;"#8.'D,BEC,FG(!&#9+9&$"0(07),'9(&33'1(+#($7"(0"4"0$"%(
*)%%"03)#9+#>(K+$7("#%)''4"#$(+#(BHI'(*JL(K<.'"55678"#4L9'8/;56.4.3'076.'9</$63'>.'9$>;744.3'5%7/%'4/'I.54.;>.%'*)4<'0/%'0"66'
8"#373"4.9'"#3'M.>%$"%&'*)4<'0/%'95%7# -'8" #3 73" 4.9G'N5 5 678"47/# 9'0/ %'"3;7997/#';"&'>.'/> 4" 7#.3 '7#'4<. 'A. 5" %4; .# 4'/0',BEC,O'
P"79.%'C"66O'Q//;')*+)G'
(
I"M,+%"4"#$0(5)%(<94+00+)#(
*G! R/;56.47/#'/0'"55678"47/#'4/'4<.'5%/0.997/#"6'5%/-%";'0/%'N4<6.478'K%"7#7#-G'
(G! I$88.990$6'8/;56.47/#'/0'S)T+)'</$%9'/0'/>9.%?"47/#'7#'4<.'"4<6.478'4%"7#7#-'0"87674&'"#3'95/%4'8/?.%"-.'"4'RRI2G'
UG! R/;56.47/#'/0'U)'8%.3749'/0'@<78<'"';7#7;$;'/0'*S'8%.3749'<"?.'>..#'."%#.3'"4'RRI2G''
1G! I$88.990$6'8/;56.47/#'/0'1'8%.3749'/0'C$;"#'N#"4/;&'E',<&97/6/-&'V'@74<'6">'DRT'/%'>.44.%'-%"3.'7#'6.84$%.'"#3'6">FG''
SG! I$88.990$6'8/;56.47/#'/0'BHI'**('"#3'BHI'(*J'"4'RRI2'DRT'/%'<7-<.%'-%"3.'7#'>/4<'8/$%9.9FG'
WG! I$88.990$6'8/;56.47/#'/0'XYI'U+)Z'BYBQ[ B \ R ]'YBAVRN^'KBRC\VRVN\'8/$%9.'/%'?.%7078"47/#'/0'.=$7?"6.#4'8/$%9.G''
G)$"A'BYKTX'8.%47078"47/#'DI4"4.'/0'RK'/%'\"47/#"6'Q.-794%&F'79'%.=$7%.3'5%7/%'4/'%.-794%"47/#'0/%'BHI'U*SG'
JG! 2#7?.%974&'[%"3.',/7#4'N?.%"-.'D[,NF'/0'(GS)'
+G! A.5"%4;.#4"6'[%"3.',/7#4'N?.%"-.'D[,NF'/0'(GJ)G'
_G! K@/'6.44.%9'/0'%.8/;;.#3"47/#Z'/#.'0%/;'"'RRI2'0"8$64&'5%.8.54/%'"#3'4<.'9.8/#3'0%/;'"'A.5"%4;.#4'/0',BEC,'0"8$64&';.;>.%'$97#-'4<.'
%.=$7%.3'0/%;9G'
*)G!K<.'5%.9.#4"47/#'/0'"#'.99"&'3.;/#94%"47#-'8/;;"#3'/0'4<.'B#-679<'6"#-$"-.O'8747#-'%." 9/ # 9 '0/% '@ "# 4 7#- '4/ '.# %/ 66'7# '4< .'5 %/ - %" ; O'5.%9/#"6'
=$"6747.9'4<"4'@/$63';":.'&/$'"'-//3'8"#373"4.O'"#3'.;5<"97`7#-'.a5.%7.#8.9'%.6"4.3'4/'"4<6.478'4%"7#7#-'DS))TJS)'@/%39FG''
**G!N#'7#4.%?7.@'@74<'4<.'I8%..#7#-'R/;;744..'/0'4<.'A.5"%4;.#4'/0',<&978"6'B3$8"47/#'"#3'C$;"#',.%0/%;"#8.O'7#86$37# -'"4'6."94'/#.'8/%.'
NKB,'0"8$64&';.;>.%G'
(
I"$"#$+)#(6)'+*1(
b#8.'"3;744.3'4/'4<.'5%/0.997/#"6'5%/-%";O'4<.'0/66/@7#-'%.=$7%.;.#49';$94'>.';"7#4"7#.3'7#'/%3.%'4/'%.;"7#'7#'c[//3'I4"#37# -d'@ 74<7# '4<. '
N4<6.478'K%"7#7#-'B3$8"47/#',%/-%";'4<.'94$3.#4';$94Z'
*G! Y"7#4"7#'"'2#7?.%974&'8$;$6"47?.'[%"3.',/7#4'N?.%"-.'D[,NF'/0'(GS)G'
(G! Y"7#4"7#'"'A.5"%4;.#4"6'[%"3.',/7#4'N?.%"-.'D[,NF'/0'(GJ)G'
UG! A.;/#94%"4.'%.=$7%.3'867#78"6'9:766'5%/0787.#87.9 ' 7#'BHI'(*+O'BHI'(1)O'BHI'U*SO'BHI'U*JO'BHI'U*WO'BHI'U*_O'E'BHI'11SG'
1G! e"673'I4"4.'/0'RK'/%'\"47/#"6'Q.-794%&'BYKTX'R.%47078"47/#'/%'<7-<.%'4<%/$-</$4'BHI'U*SO'BHI'U*JO'BHI'U*WO'BHI'U*_O'E'BHI'11SG'
'
R"#373"4.9'@</'3%/5'>.6/@'4<.'%.=$7%.3'[,N'6.?.69f'"#3g/%'0"769'4/'8/;56.4.'4<.'9:766'5%/0787.#87.9f'"#3g/%'0"769'4/';"7#4"7#'BYK'
R.%47078"47/#O';"&'>.'3.#7.3'.#%/66;.#4'4/'5%/0.997/#"6'5%/-%";'8/$%9.9O'5%"8478$;'8/$%9.9'"#3'7#4.%#9<75'"997-#;.#49'$#476'4<.'
[,N'"#3g/%'8/;5.4.#87.9'%."8<'4<.'"55%/5%7"4.'6.?.6f'"#3g/%'BYK'8.%47078"47/ # '79 '? "673 G '
'
R"#373"4.9'@</'0"76'4/';..4'4<.'[,N'%.=$7%.;.#4'#..3.3'0/%'"55678"47/#'4/'4<.'5%/0.997/#"6'5%/-%";'0/%'4@/'8/#9.8$47?.'
9.;.94.%9'"04.%'8/;56.47#-'BHI'(*J'@766'#/'6/#-.%'>.'"66/@.3'4/'"556&'4/'4<.'"4<6.478'4%"7#7#-'5%/0.997/#"6'5%/-%";G''
'
6'"&0"(G)$"A'Q.?797/#9'4/'4<.'"4<6.478'4%"7#7#-'.3$8"47/#'5%/-%";';"&'/88$%'7#'/%3.%'4/';"7#4"7#'8/;567"#8.'@74<'#"47/#"6'"88%.374"47/#'
94"#3"%39G''I4$3.#49'9</$63'8<.8:'@74<'4<.'5%/-%";'37%.84/%'"#3g/%'4<.'RRI2'"4<6.478'4%"7#7#-'.3$8"47/#'@. >974.'%.-"%37#-'4<.'5/ 997>7674&'/0'
#.@'%.=$7%.;.#49G'
(
=%&#05"%(6)'+*1(
K%"#90.%'94$3.#49';$94';..4'4<.'9";.'8/$%9.'%.=$7%.;.#49'"#3'"55678"47/#'5%/8.3$%.9G'K%"#90.%'94$3.#49'"%.'%.=$7%.3'4/'
8/;56.4.'"';7#7;$;'/0'*S'8%.3749'c7#'%.973.#8.d'"4'RRI2'5%7/%'4/'"556&7#-'4/'4<.'5%/0.997/#"6'5%/-%";G''K<.'*S'c7#T%.973.#4d'
8%.3749'0/%'4%"#90.%'94$3.#49';"&'>.'7#'[.#.%"6'B3$8"47/#'"#3g/%'@74<7#'4<.'N4<6.478'K%"7#7#-'B3$8"47/#',%/-%";'"#3';$94'
7#86$3.'BHI'**('"#3'BHI'(*J'"4'RRI2G'R$%%.#46&O'"66'%.=$.949'0/%'4%"#90.%'7#4/'4<.'N4<6.478'K%"7#7#-'B3$8"47/#',%/-%";'.74<.%'
>&'94$3.#49'0%/;'/4<.%'$#7?.%9747.9'/%'>&'RRI2'94$3.#49'6//:7#-'4/'8<"#-.';"h/%9'"%.'<"#36.3'/#'"'8"9.T>&T8"9.'>"979G''K<.'
#$;>.%'/0'94$3.#49'"88.54.3'7#'4<79';"##.%'3.5.#39'/#'4<.'#$;>.%'/0'/5.#7#-9'"?"76">6.'7#'4<"4'&."%G'M/%'"88.54"#8.'7#4/'
4<.'N4<6.478'K%"7#7#-'B3$ 8"47/ # ',%/-%";O'4%"#90.%'94$3.#49';$94'8/;56.4.'4<.'%.=$7%.3'D;7#7; "6F' S)T+)'</$%9'/0'/>9.%?"47/#'
7#'4<.'"4<6. 478 '4%" 7# 7# -'0" 8 7674& '"# 3 '9 5 / %4'8/ ? . %" -. '"4 'R R I2G'
!"#$"%&'()*+'
,"-.'('/0'1
(
(
!
!"#$%&'(!)##"*$+*,$(-$&$"(.#+/"%0+$1(
2"3&%$4"#$()5(6710+*&'(89,*&$+)#(:(;,4&#(6"%5)%4&#*"(
<33'+*&$+)#(5)%(<94+00+)#(+#$)($7"(<$7'"$+*(=%&+#+#>(89,*&$+)#(6%)>%&4'
6'"&0" (=13"()%(6%+#$(
(
G&4"A((NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN( !!-.(-$,9"#$(E2(OA((NNNNNNNNNNNNNNNNNNNNNNNN(
(((((((((((((((((((((H&0$((( ( (((((((@+%0$( (( ((((((((((((((DLEL(
(
!"''(67)#"A(NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN( ( ( 84&+'A(NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN(
(
;)4"(<99%"00A( NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
( ( ( -$%""$(<99%"00( ( ((((((((((((((((((((((((((((((((((((!+$1( ( -$&$"(( ( ( P+3(
(
H)*&'(<99%"00(Q+5(9+55"%"#$RANNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN(
( ( ( -$%""$(<99%"00( ( ((((((((((((((((((((((((((((((((((((!+$1( ( -$&$"(( ( ( P+3(
(
!
(!7"*S'+0$(T6'"&0"(+#*',9"($7"(5)'')K +#> A((
(
"
(800&1(
"
(=K)(H"$$"%()5(I"*)44"#9 &$+)#(@)%4 0(
"
(.#)55+*+&'(=%&#0*%+3$U()?$&+#(5%)4(V3+3"'+#"W(
"
(D&X)%(J6<(@)%4(T()?$&+#(5%)4(&$7'"$+*($%&+#+#>(5&*,'$1(&9/+0)%(
"
(!'+#+*&'(;),%(Y"%+5+*&$+)#(@)%4(T()?$&+#(5%)4(&$7'"$+*($%&+#+#>(5&*,'$1(&9/+0)%(
"
(-+>#"9(="*7#+*&'(-$&#9&%9(@)%4(
"
(Y"%+5+*&$+)#()5(*)43'"$+)#(84"%>"#*1(D"9+*&'(="*7#+*+&#(!),%0"(!)43'"$+)#(
"
(!,%%"#$(-$&$"()5(!=()%(G&$+)#&'(I">+0$%1(8D=(!&%9(+5(&/&+'&?'"(&$($+4"()5(&33'+*& $+) # L(
(
(
(
(
(
(
(
(
(
(
(
(
(
(
(
(
(
(
(
'
'
'
EZ(NNNNNNN N N NN N N N N NN N N N NN N N N N NN N N N N(7 " % " ? 1(& 3 3 '1(5 )% (& 94+00+)#($)($7 " (< $7 '" $+* (= %& +# +# >(8 9 , *& $+) # (6 % )> % &4(&$(!"#$%& '(
!)##"*$+*,$(-$&$"(.#+/"%0+$1L((E(7&/"(%"&9(&#9(5,''1(,#9"%0$&#9($7"(%"M,+%"4"#$0(5)%(&94+00+)#(&#9(5)%(%"$"#$+)#(+#($7"(<$7'"$+*(
=%&+#+#>(89,*&$+)#(6%)>%&4L(
'
'
2&$"A''iiiiiiiiiiiiiiiiiii' ' -$,9"#$[0(-+>#&$,%"A''iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii'
Attach Front Side of Current EMT Card
Attach Back Side of Current EMT Card
!"#$"%&'()*+'
,"-.'U'/0'1
(<33'+*&$+)#(5)%(<94+00+)#(+#$)($7"(<$7'"$+*(=%&+#+#>(89,*&$+)#(6%)>%&4(T(Q*)#$+#,"9R(
(
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN( ( ( ( NNNNNNNNNNNNNNNNNNNNNNNNNNNNN(
-$,9"#$[0(G&4"A(H&0$Z(@+%0$Z(DE( ( ( ( ( ( ((((((((((((((((((((((((((((((((!!-.(-$,9"#$(E2(O(
(
-$,9"#$0(6'"&0"(2)(G)$(\%+$"(E#(-"*$+)#(]"')KA(@)%(2"3&%$4"#$(-*%""#+#>(!)44+$$""(.0"(F#'1(
(
2&$"(<33'+*&$+)#(I"*"+/"9A((NNNNNNNNNNNNNNNNNN( ( E#$"%/+"K (-*7" 9,'"9A(NNNNNNNNNNNNNNNNNN(
(
I"M,+%"9(!%"9+$0Z(J6<Z(<=(F?0"%/&$+)#(;),%0((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((
^"0(
E#U6%)>%"00(
''U)'R%.3749'B"%#.3O'*S'R%.3749'B"%#.3'"4'RRI2'
'
'
'''2#7?.%974&'[,N'(GS)';7#7;$;'
'
'
'''A.5"%4;.#4"6'[,N'(GJ)';7#7;$;'
'
'
'''S)T+)'C/$%9'b0'N4<6.478'K%"7#7#-'b>9.%?"47/#'T'e.%7078"47/#'M/%;'N44"8<.3'
'
'
'
(
(
(
(
I"M,+%"9(<*&9"4+*(!),%0"(!)43'"$+)#(:(J%&9"(
^"0(
E#U6%)>%"00(
'''BHI'**(''DRT'/%'>.44.%F(
'
'
'''BHI'()J'"#3'BHI'(**'/%''1'8%.3749'C$;"#'N#"4/;&'E',<&97/6/-&'V''
'
'
'''BHI'(*J'DRT'/%'>.44.%F'
'
'
'''XYI'U+)'/%'BYK'R/$%9.'R/;56.47/#'
'
'
'
'
'
'
'
I"M,+%"9(="*7#+*&'(-$&#9&%90(
^"0(
(
'''K.8<#78"6'I4"#3"%39'A/8$;.#4'I7-#.3'E'A"4.3'
'
'
'''I4$3.#4'Q.=$.947#-'N88/;;/3"47/#9'0/%'K.8<#78"6'I4"#3"%39'
'
'
(
800&1(:(E#$"%/+"K(-*)%+#>(?1(!)44+$$""(D"4?"%0'
'''B99"&'''''''''''''''''''''''''''''*G)'' *GS' (G)' (GS' UG)'
,"99'
'
Q.TI$>;74'
'''V#4.%?7.@ ''''''''''''''''''''''*G)'' *GS' (G)' (GS' UG)'''''''''''
,"99'
Q.TV#4.%?7.@'
'
I7-#"4$%.'R/%.'NK'M"8$64&A(iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii'''''A"4.Z'iiiiiiiiiiiiiii(((''''''''''''''''''''''''''''''''''''''
'
B99"&'''''''''''''''''''''''''''''*G)'''''*GS'''''(G)'''''(GS'''''UG)'
,"99'
'
Q.TI$>;74'
V#4.%?7.@ ''''''''''''''''''''''*G)'''''*GS'''''(G)'''''(GS'''''UG)'
,"99'
Q.TV#4.%?7.@'
'
I7-#"4$%.'R/;;744..'Y.;>.%'7#'N44.#3"#8.Z'iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii'''''A"4.Z'iiiiiiiiiiiiiii''''
'
B99"&'''''''''''''''''''''''''''''*G)'''''*GS'''''(G)'''''(GS'''''UG)'
,"99'
'
Q.TI$>;74'
V#4.%?7.@ ''''''''''''''''''''''*G)'''''*GS'''''(G)'''''(GS'''''UG)'
,"99'
Q.TV#4.%?7.@'
'''''''''''''''''''''''''''''''
I7-#"4$%.'R/;;744..'Y.;>.%'7#'N44.#3"#8.Z'iiiiiiiiiiiiiiiiiiiiiiiiiiiiiii''''A"4.Z'iiiiiiiiiiiiiii''''
(
<94+00+)#A( _<33%)/"9( _2"5"%%"9( _I"X"*$"9( (
(
!)44"#$0A(NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN(
(
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN( ( NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN( ( NNNNNNNNNN(
((((((((((68:;6(!7&+%[0(G&4"(6%+#$"9(( ( ((((((((((((68:;6(!7&+%[0(-+>#&$,%"( ( ( (((((((2&$"(
(
(
(
(
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
!"#$"%&'()*+'
,"-.'1'/0'1
<33'+*&$+)#(5)%(<94+00+)#(+#$)($7"(<$7'"$+*(=%&+#+#>(89,*&$+)#(6%)>%&4(
="*7#+*&'(-$&#9&%90(@)%4(
K<.'N4<6.478'K%"7#7#-'B3$8"47/#"6',%/-%";'"4'R.#4%"6'R/##.8478$4'I4"4.'2#7?.%974&'79'"'%7-/%/$9'"#3'7#4.#9.'5%/-%";'4<"4'56"8.9'
95.87078'%.=$7%.;.#49'"#3'3.;"#39'/#'4<.'94$3.#49'.#%/66.3'7#'4<.'5%/-%";G'K<.'4.8<#78"6'94"#3"%39'9.4'0/%4<'>&'4<.'N4<6.478'
K%"7#7#-'B3$8"47/#"6',%/-%";'.94">679<'4<.'.99.#47"6'=$"6747.9'8/#973.%.3'#.8 .9 9" %&'0 / %'94$ 3 . # 49'" 3 ;744.3'4/'4<79'5 %/ - %" ;'4/'
"8<7.?.'4<.':#/@6.3-.O'9:7669O'"#3'8/;5.4.#87.9'/0'"#'.#4%&T6.?.6'"4<6.478'4% "7# . %O'" 9'@ . 66'" 9';..4'4<.'.a5 .8 4" 47/ # 9'/ 0 '4< .'
5%/-%";L9'"88%.3747#-'"-.#8&'DCommission!on!Accreditation!of!Athletic!Training!Education!jRNNKBkFG''N66'94$3.#49'"3;744. 3'4/ '4< .'
5%/0.997/#"6'5%/-%";'7#'4<.'N4<6.478'K%"7#7#-';$94';..4'4<.'0/66/@7#-'">76747.9'"#3'.a5.84"47/#9G''V#'4<.'.?.#4'"'94$3.#4'79'$#">6.'
4/'0$60766'4<.9.'4.8<#78"6'94"#3"%3 9O'4<.'94$3 .#4'will!not!be!admitted'7#4/'4<. '5 %/ -% ";G''Rompliance!with!the!program’s!technical!
standards!does!not!guarantee!a!student’s!eligibility!for!the!BOC!certification!exam.!
R"#373"4.9'0/%'"3;7997/#'4/'4<.'5%/0.997/#"6'5%/-%";'7#'N4<6.478'K%"7#7#-'"4'RRI2';$94'3.;/#94%"4.Z'
K<.'">7674&'4/'"997;76"4.O'"#"6&`.O'9&#4<.97`.O'7#4.-%"4.'8/#8.549'"#3'5%/>6.;'9/6?.'4/'0/%;$6"4.'"99.99;.#4'"#3'4<.%"5.$478
h$3-;.#49'" # 3 '4/ '> . '"> 6. '4/ '3 7947# - $ 79< '3 . ?7" 47/ # 9'0 %/ ; '4< . '# / %;G'
B?73.#8.'/0'9$00787.#4'5/94$%"6'"#3'#.$%/;$98$6"%'8/#4%/6O'9.#9/%&'0$#847/#O'"#3'8//%37#"47/#'4/'5.%0/ %; '"5 5%/ 5%7" 4.'5< &978" 6
.a";7#"47/#9'$97#-'"88.54.3'4.8<#7=$.9f'"#3'4<.'3.;/#94%"4.3'">7674&'4/'"88$%"4.6&O'9"0.6&'"#3'.00787.#46&'$9.'.=$75;.#4'"#3
;"4.%7"69'3$%7#-'4<.'"99.99;.#4'"#3'4%."4;.#4'/0'5"47.#49G
K<.'">7674&'4/'8/;;$#78"4.'.00.847?.6&'"#3'9.#9747?.6&'@74<'5"47.#49'"#3'8/66."-$.9O'7#86$37#-'7#37?73$"69'0%/;'3700.%.#4'8$64$%"6'"#3
9/87"6'>"8:-%/$#39f'4<79'7#86$3.9O'>$4'79'#/4'67;74.3'4/O'">7674&'4/';"7#4"7#'"'5%/0.997/#"6'3.;."#/%O'.94">679<'%"55/%4'@74<'5"47.#49O
"#3'8/;;$#78"4.'h$3-;.#49'"#3'4%."4;.#4'7#0/%;"47/#'.00.847?.6&G'I4$3.#49';$94'>.'">6.'4/'$#3.%94"#3'"#3'95.":'4<.'B#-679<
6"#-$"-.'"4'"'6. ?. 6'8/ # 979 4. # 4'@ 74< '8/ ;5.4.#4'5%/0.99 7/ #" 6'5 %" 8478 .G
K<.'">7674&'4/'%.8/%3'4<.'5<&978"6'.a";7#"47/#'%.9$649'"#3'"'4%."4;.#4'56"#'86."%6&'"#3'"88$%"4.6&G
K<.'">7674&'4/';"7#4"7#'8/;5/9$%.'"#3'8/#47#$.'4/'0$#847/#'.00.847?.6&'3$%7#-'5.%7/39'/0'<7-<'94%.99G'
K<.'5.%9.?.%"#8.O'3767-.#8.'"#3'8/;;74;.#4'4/'8/;56.4.'4<.'"4<6.478'4%"7#7#-'.3$8"47/#'5%/-%";'"9'/$467#.3'"#3'9.=$.#8.3G
M6.a7>7674&'"#3'4<.'">7674&'4/'"3h$94'4/'8<"#-7#-'974$"47/#9'"#3'$#8.%4"7#4&'7#'867#78"6'974$"47/#9G'
K<.'">7674&'4/'5.%0/%;'4<.'"00.847?.'9:7669'4<"4'%.6"4.'4/'5%/0.997/#"6'.3$8"47/#'"#3'=$"674&'5"47.#4'8"%.G'
RRI2l9'4.8<#78"6'94"#3"%39'%.6"4.'4/'/#.l9'">7674&'4/'0$#847/#'7#'"'>%/"3'?"%7.4&'/0'"8"3.;78'"#3'867#78"6'974$"47/#9'"#3'4/'%.#3.%'"'
@73.'95.84%$;'/0'4</$-<4O'3.8797/#O'"#3'8"%.'4/'"4<6.4.9'"#3'/4<.%9'7#37?73$"69'.#-"-.3'7#'5<&978"6'"847?74&G'R"#373"4.9'0/%'
"3;7997/#'4/'4<.'5%/0.997/#"6'5%/-%";'7#'"4<6.478'4%"7#7#-'@766'>.'%.=$7%.3'4/'?.%70&'4<.&'$#3.%94"#3'"#3';..4'4<.9.'4.8<#78"6'
94"#3"%39'/%'4<"4'4<.&'>.67.?.'4<"4O'@74<'8.%4"7#'"88/;;/3"47/#9O'4<.&'8"#';..4'4<.'94"#3"%39G ''
N'94$3.#4'@</'>.67.?.9'4<"4'4<.&'<"?.'"'379">7674&'4<"4';"&'7;5"84'"3;7997/#'4/'/%'9$88.990$6'8/;56.47/#'/0'4<79'5%/-%";'9</$63 '
8/#4"84'RRI2l9'I4$3.#4'A79">7674&'I.%?78.9'7#'R"%%/66'C"66O'Q;'*S)O',</#.'D+W)F'+U(T*_S(O'M"a'D+W)F'+U(T*+WSO'.;"76'
A79">7674&I.%?78.9m889$G.3$G'The!Office!of!Student!Disability!Services!will!evaluate!the!student’s!documentation!to!determine!if!
the!stated!condition !qu alifies!as!a!d isability!un de r!ap plicab le!law s!an d!so !notify!the!Program!Director!of!Athletic!Training!
Education!Program!and!the!Chair!of!the!Department!of!Physical!Education!&!Human!Performance.!
V0'"'94$3.# 4'@74<'"'=$"6707. 3 '3 79 " > 7674&'9 4" 4. 9 '< .g 9 < .'8 " # ';..4'4<.'4.8< # 78 " 6'94 "# 3 " %3 9 '@74<'"88/; ;/3"47/#O'4 < .# '4<.'94$3. #4'"# 3'
"55%/5%7"4.'2#7?.%974&'5.%9/##.6'@766'3798$99'@<"4'"88/;;/3"47/#D9F';"&'>.'.00.847?.'"#3'@<.4<.%'4<.'"88/;;/3"47/#9'
%.=$.94.3'"%.'%."9 /# "> 6.O'4":7# -'7#4/ '"88/ $ #4'867#787" #g 5" 47.#4'9" 0.4&O'"# 3'@ < .4< .%'4<. '%.=$ .94. 3'" 88/;;/3"47/# 9'@ /$ 63'
0$#3";.#4"66&'"64.%'4<.'#"4$%.'/0'4<.'5%/-%";O'7#86$37#-'"8"3.;78'94"#3"%39G''
I4$3.#49';"&'$53"4.'<."64<'94"4$9'8<"#-.9'"4'"#&'47;.'>&'9$>;7447#-'4<.'c="*7#+*&'(-$&#9&%9(@)%4W'4/'4<.'5%/-%"; '37%.84/ % (&#9'
8/#4"847#-'RRI2l9'-$,9"#$(2+0&?+'+$1(-"%/+*"0'4/'3.4.%;7#.'@<"4'"88/;;/3"47/#9';"&'>.'"?"76">6.G'
V'8.%470&'4<"4'V'< " ? .'% ." 3 '" # 3 '$ # 3 . %9 4" # 3 '4< . '4.8<#78"6'94"#3"%39'6794.3'" > / ?. G''6'"&0"(*7"*S($7"(&33%)3%+&$"(?)`L(
"! V'>. 67. ?. '4/ '4 < .'> . 9 4'/ 0';&':#/@6. 3 - . '4< " 4'V';..4'."8<'/0'4<.9.'94"#3"%39G''V'$#3.%94"#3'4<"4'70'V'";'$#">6.'4/';..4'4<.9.'
94"#3"%39'V'@766'#/4'>.'"3;744.3'7#4/'4<.'5%/-%";G'
"! V'>. 67. ?. '4/ '4 < .'> . 9 4'/ 0';&':#/@6. 3 - . '4< " 4'V'8" # ';..4'."8<'/ 0 '4< . 9. '9 4" # 3 "% 3 9'@74<'8.%4"7#'" 8 8/ ;;/3"47/ # 9 G''V'@766'8/#4"84'
RRI2l9'-$,9"#$(2+0&?+'+$1(-"%/+*"0'4/'3.4.%;7#.'@<"4'"88/;;/3"47/#9';"&'>.'"?"76">6.G'V'$#3.%94"#3'4<"4'70'V'";'$#">6.'4/'
;..4'4<.9.'94"#3"%39'@74<'/%'@74</$4'"88/;;/3"47/#9O'V'@766'#/4'>.'"3;744.3'7#4/'4<.'5%/-%";G'
iiiiiiiiiiiiiiiiiiiiiiiiiiiiii' iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii' iiiiiiiiiiii'
'''''''''''''I4$3.#4l9',%7#4.3'\";.' ''''''I4$3.#4l9'I7-#"4$%.' ''A"4.'
N55%/?.3'>&'2#7?.%974&'R/$#9.6'Ug*)g)U'