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All items with a red asterisk * must be completed. If you do not know the correct response type in unknown or NA.

Applicant's Name *

Date *

[MM-dd-yy]

1 = Poor 10 = Excellent

1. Honesty and integrity *

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2. Responsibility and reliability *

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3. Organization *

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4. Willingness to do the behind-the-scenes unpleasant chores *

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5. Ability to follow orders *

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6. Willingness to work long hours *

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7. Shows a personal interest in the athlete *

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8. Treats athletes without discrimination *

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9. Has an enthusiastic attitude *

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10. Demonstrates initiative in work *

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11. Ability to get along with colleagues *

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12. Personal appearance and hygiene *

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13. Mechanical ability *

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14. Enforces athletic training room regulations *

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15. Stays within the limits of athletic training responsibilities (does not coach or play doctor) *

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16. Adhesive taping ability *

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17. Knowledge of injury evaluation *

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18. Knowledge and application of first aid skills *

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19. Injury wrapping ability *

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20. Knowledge and use of athletic training room supplies *

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21. Knowledge of general athletic training room administration *

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22. Application and knowledge of therapeutic modalities *

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23. General knowledge of conditioning exercises *

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24. General knowledge of basic rehabilitation of injuries *

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25. Ability to construct special injury pads *

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Evaluating Athletic Trainer's Name *

Evaluating Athletic Trainer's Title *

Work Phone *

FAX *

E-mail *

Are you a current member of the NATA? *

NATA Membership Number *

How many years? *

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