Shenandoah University
1460 University Drive
Winchester, VA 22601
(540)545-7386
mfrederi@su.edu
VIRGINIA
APPLICATION
FOR
SCHOLARSHIP AWARD
NOTE
This nomination form, with supporting academic
transcript, must be postmarked by April 15 for
candidate to be eligible for this award.
HIGH SCHOOL STUDENT SCHOLARSHIP
AWARD
APPLICATION FORM
GENERAL REGULATIONS
Through the High
School Student Scholarship Program, the Virginia Athletic Trainers Association
(VATA) offers two scholarships each year to deserving high school seniors who
intend to study Athletic Training upon graduation. The scholarships are
designed to recognize outstanding high school students and are based primarily
upon individual merit. The scholarship amount is $1,000 for the winner and $500
for the runner-up. No secondary school may nominate more than one candidate.
The scholarship monies will be sent directly to the candidate's student account
at the college or university to which the candidate has been accepted.
CRITERIA
FOR SELECTION
The VATA High School Student Scholarship Program seeks to recognize students who demonstrate excellent potential for a career in the allied health profession of Athletic Training. In granting the scholarships, the VATA will consider the following:
1. Scholarship ability
2. Leadership ability
3.
Responsible citizenship
4.
Dedication/Interest in Athletic
Training
CONDITIONS OF ELIGIBILITY
To be eligible for
the VATA scholarship, a candidate must:
1. Be a
member of the current graduating class of a secondary school in the
2. Verify admission to an accredited
institution of higher learning with the intention to pursue a NATA
accredited curriculum program.
3. Provide evidence of interest in
Athletic Training through experience as a high school student athletic trainer
and/or attendance at an athletic training seminar or workshop.
NOMINATION
PROCEDURE
The completed nomination form must be postmarked by 15 APRIL
to the following address:
Ms. Terry Zablocki,
322
(757) 628-9189
tzabloki@nps.k12.va.us
VATA HIGH SCHOOL
NOMINATION FORM
|
Note: PLEASE TYPE OR PRINT CLEARLY |
Name in full:
__________________________________________________________________
(LAST) (FIRST) (MIDDLE)
Home
Address: _______________________________________________________________
________________________________________________________________
Email Address:________________________________________________________________
Home Telephone Number: _______________________________________________________________
(Area Code) (Number)
Date of Birth:
_________________________________________________________________________
Social
Security Number:
________________________________________________________________
Name of High School:
__________________________________________________________________
Name
of High School Principal: __________________________________________________________
Name of Nominating Official:
____________________________________________________________
Title :
____________________________________________________________
School Mailing Address:
________________________________________________________________
_________________________________________________________________
School Telephone Number:
______________________________________________
(Area Code)
(Number)
NOMINATING
OFFICIAL'S FORM
Name of Nominee:
_____________________________________________________________
(Print)
To the Nominating
Official (e.g., Athletic Trainer, Physician, School
Nurse): Please provide a candid assessment of the candidate's potential for a
career in the allied health profession of Athletic Training. The award is based
on excellence in scholarship, leadership, and citizenship.
PLEASE
PRINT OR TYPE.
Name of Nominating Official:
_______________________________________________
(Print)
_______________________________________________
(Signature)
Title:
___________________________________________
VATA HIGH SCHOOL
SCHOOL ENDORSEMENT
FORM
Name of Nominee:
_____________________________________________________________
(Print)
To
the Principal, Headmaster, or Guidance Counselor: Please provide a candid
assessment of the candidate's potential for a career in the allied health
profession of Athletic Training. This award is based on excellence in
scholarship, leadership, and citizenship. Please attach a properly certified
transcript for grades 9-12 and a record of SAT and Achievement Test scores.
Please verify the candidate's admission and acceptance to an
accredited institution of higher learning. PLEASE PRINT OR TYPE.
Name of Endorsing Official:__________________________________________________
(Print)
__________________________________________________
(Signature)
Title:
______________________________________________
VATA HIGH SCHOOL STUDENT SCHOLARSHIP AWARD
EXTRA-CURRICULAR ACTIVITIES
REPORT
Please list, in order
of importance, your activities in Athletic Training including related endeavors
outside the classroom. Note the school year of the activity. Include any summer
employment opportunities you have had. You may use the back of this sheet if
necessary. REMEMBER TO PRINT OR TYPE.
Activity
Positions Held Year
HONORS AND SPECIAL
RECOGNITION
Please list any
significant honors and special recognition you have received for academic or
extra-curricular achievements.
VATA HIGH SCHOOL
PERSONAL ESSAY
Name
of Candidate: __________________________________________________________
(Print)
Please compose a personal essay of 250-500 words. Use this
essay to help the members of the VATA Education Committee learn more about you
and your interest in a career in the allied health profession of Athletic
Training. In this regard, you might describe an influential person in your
life. Describe your goals for the
future. Please include a description of your intentions for college and the
program of study in Athletic Training that you intend to follow. PLEASE PRINT
OR TYPE. Use the back of this sheet if necessary.
Signature
of candidate: ____________________________________________
Date:______________________________