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ATAF Annual ATC Award
Nomination Response Form
CONGRATULATIONS! You have been nominated for ATAF Honorary Membership or Sports Medicine Person of the Year 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 Sports Medicine Person of the Year Award:
A.Awarded to any sports medicine professional regardless of field.
B.Membership in ATAF not required.
C.Must be nominated by a member of ATAF.
D.Award based on outstanding dedication to the profession of Athletic Training over the past year.
Criteria for ATAF Honorary Membership:
A.Awarded to any person regardless of field.
B.Award 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:
Please fill out all applicable information. If information does not apply please enter N/A. For Sports Medicine Person of the Year Award nominees, please fill out all applicable information. Emphasis will be placed on work done in the past year. For Honorary Membership nominees, emphasis will be placed on body of work over the past 10 years.
Name:
Address:
NATA Membership Number:
NATABOC Cert. Number:
FL Athletic Training License Number:
Other Credentials:
Employer:
Employers E-mail address:
Employers Address:
Work Setting:
1.How long have you been associated with Athletic Trainers?
2.Are you an ATAF member?
3.List any involvement in committees with ATAF (include the years).
4.List 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.List any involvement you have related to Athletic Training education?
8.List any responsibilities you have had related to Athletic Training program development
9.List any legislation related to Athletic Training you have introduced, supported, promoted, or voted on.
10. List any involvement you have had in developing a product or equipment related to Athletic Training.
11. List any activities you have participated in that have promoted or are related to Athletic Training.
12. List events that you have covered separate from your regular full time duties. (I.E.: Regional, State,
National, or International sporting events)
13. List all Athletic Training related volunteer work not listed above you have done over the past five years with the corresponding years.
14. Please list any other activities that you have participated in (i.e. publications, presentations,
speaking engagements, …etc.) over the past 10 years with the corresponding years.
15. Please list any other information from the past 10 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
