12780 Waterford Lakes Pkwy Suite 115, Orlando FL 32828
Elite Founding Partner
ATAF Annual ATC Award
Nomination Response Form
CONGRATULATIONS! You have been nominated for an ATAF Award. Please take a few moments to fill out the information below and return it to the Chair of the Awards Committee by TBD. All information must be received by the deadline in order to be considered for this award. You will find the specific award criteria for the award you have been nominated for at www.ataf.org, on the awards committee page. Thank you and good luck.
Criteria for High School, College/University, Professional, Clinical Corporate Athletic Trainer of the Year Awards and Professional Outreach Award:
A.Certified Athletic Trainer
B.Licensed as an ATC in the State of FL
C.Member of ATAF for 5 years.
Criteria for Sports Medicine Person of the Year are based on dedication to the profession of Athletic Training over the past year and Honorary Membership is based on outstanding dedication to the Athletic Training Profession over the past 10 years.
By submitting this form, I agree that I have read the Awards Criteria and I meet all requirements.
Please complete all that apply:
Name:
Employer:
NATA Membership Number:
Employers E-mail address:
FL Athletic Training License Number:
Other Credentials:
Employers Address:
Work Setting:
1.How long have you been a Certified Athletic Trainer?
2.How long have you been an ATAF member?
3.List any offices held or any involvement in committees with ATAF (include the years).
4.List any offices held or any involvement in committees for SEATA and/or NATA (include the years).
5.List any education or teaching you provide related to Athletic Training.
6.Do you supervise student athletic trainers?
7.Are you an Accredited Clinical Instructor (ACI)?
8.List any responsibilities you have had related to Athletic Training program development
9.List any involvement you have had in developing a product or equipment related to Athletic Training
10. List any activities you have participated in that have promoted or are related to Athletic Training
11. List events that you have covered separate from your regular full time duties. (I.E.: Regional, State, National, or International sporting events.
12. List all Athletic Training related volunteer work not listed above you have done over the past five years with the corresponding years.
13. Please list any other activities that you have participated in (i.e. publications, presentations,
speaking engagements, …etc.) over the past 5 years with the corresponding years.
14. Please list any other information from the past 5 years that you feel is pertinent to your nomination.
All information must be emailed to: ggillis@bellsouth.net by TBA in order to be considered for an award.
1.Completed Nomination Form (submitted by clicking the submit button).
2.Three Letters of Recommendation
a.Letter from employer
b.Letter from an ATC
c.One other – any source
If you have any questions regarding any form or process, please contact Gary Gillis at the linked e-mail address. ggillis@bellsouth.net
