Prospective Barton Student Athletic Trainer

Email Secondary Email

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Email address *

First name *

Last name *

Address 1 *

Address 2

City *

State *

ZIP Code *

Date of Birth: *

Cell Phone #: *

Father's Name & Occupation:

Mother's Name & Occupation:

High School Name:

High School Information

City, State, Zip

Date of High School Graduation:

Current Grade Point Average:

Honors, Extra-Curricular Activities, etc

Have you taken any college courses or attended another college or univerisity?

If yes: Name of college and dates of attendance

What is your intended college major?

What sport(s) have you participated in as a student athletic trainer/manager?

If you have experience, what is the name of the coach(es) you participated with?

What sport(s) have you participated in as an athlete?

Also include what grade in school you are/were when you participated in that sports(s)

Do you intend to be an athlete and/or get involved with band and/or choir, etc, should you attend Barton?

Yes No

If yes, please provide details:

What are your hobbies and/or interests?

What is your current interest level in Barton?

Very Strong Strong Some Unsure

* required field

Barton Community College Athletics