GLATA Officer Nomination Form
Great Lakes Athletic Trainers' Association
Elected Office Nomination Form
Athletic Training Qualifications and Experiences
Nomination for
BOC Certification Number
First Name
Last Name
Home Address
Office Address
City
City
State Zip
State Zip
Home Phone Office Phone
Email Office Fax
   
Education  
College Degree Years
     
Specialized Training & Qualifications    
  • Name and places of Athletic Training Duties (please list a maximum of 5)
  • Special games or contests (Please limit to 5 games/contests)
     
Publications (Books, Articles, Professional Publications (please list the 10 most recent)
 
Awards, Lectures, Other endeavors critical to Atheltic Training (please list the 15 most recent)
 
Offices Held (provide a complete list of offices held in the past 10 years)
 
Summary Statement for this GLATA Office (please limit to 100 words)

DO NOT ATTACH your professional or faculty vita to this nominations form– complete form as requested above. Incorrectly completed forms will be returned to the candidate and not considered as an acceptable nominations form.