Personal Information:

Name: ________________________________________________ Address: _______________________________________________ Date: ____________________ Zip Code: __________________

Home Phone: _______________________________ Cell Phone: _____________________________ Parents/Guardian: _____________________________________________________________________

Academics:
Grade (Next Year): 9th 10th 11th YES 12th NO

Have you ever failed a grading period and/or class?

If answered YES, which class(es): __________________________________________________________

Conduct:
Have you ever had been assigned ISS? YES NO

If answered YES, how many times? _________ List any other disciplinary problems you have had while in school: _____________________________________ _____________________________________________________________________________________

Other:
Do you currently have a job? YES NO YES YES NO NO

If answered YES, will your job accommodate time off for games and practices? If answered NO, are you planning to get a job during the school year?

List any other programs/extra-curricular activities that might impede you from attending games and practices on a regular basis: ______________________________________________________________________

_____________________________________________________________________________________ The Bronco Sports Medicine Program is one that strives for excellence in education and in its care of athletes. The Student Athletic Trainers are expected to work hard and be as dedicated to this program as any athlete is to their sport. They are also expected to abide by the same grading policy as athletes, as well as the school and district athletic codes. If admitted for consideration, you will be a Student Trainer Candidate and will placed on a four-week probation period. You will be expected to abide by the policies and procedures detailed in the Student Trainer Handbook, as well as the MISD Co-Curricular Code of Conduct and the MISD Random Student Drug Testing Contract. During this probation period both the Supervising Athletic Trainer and Student Trainer Candidate reserve the right to terminate their position in the program. Should a Student Trainer Candidate fail to complete the 4 week probation period they will be removed from athletics (if applicable) and will not be permitted to apply again. Please initial by each of the following statements. (Your initials will serve as your agreement to each statement. Failure to initial a statement will result in an incomplete application and you will be prevented from applying to the Bronco Sports Medicine Program.) ______ I understand that by applying to become a Student Trainer Candidate I will be expected to abide by the policies and procedures detailed in the Student Trainer Handbook and the guidelines established by the MISD Code of Conduct and the MISD Random Student Drug Testing Policy. ______ I understand that by becoming a Student Trainer I will be expected to follow the same grading policy as the athletes. ______ I understand that by becoming a Student Trainer I will be expected to work TWO (2) sports during the school year. ______ I understand that becoming a Student Trainer is a major time commitment and I will be expected to stay afterschool for practices and/or games. ______ I understand that becoming a Student Trainer might include working on weekends and/or holidays. I certify that the information contained in this application is correct to the best of my knowledge. I understand that to falsify information is grounds for refusing to accept me into the Bronco Sports Medicine Program, or for discharge should I be accepted.

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Student Signature _____________________________________________________ Parent/Guardian Signature

Date _____________________ Date

Office Use Only Start Date: _______________________ Approved for Athletics: Y N ___________________