Become an Athletic Trainer

Allen Community College

Red Devil Athletic Training Questionnaire

1801 N. Cottonwood
Iola, KS 66749

Andrea Holly, Athletic Trainer
holly@allencc.edu
Phone: 620-365-5116, ext. 297
Fax: 620-365-7406

Please fill out the following information and submit.

Date: Year in School: FR SO JR SR
The purpose of this questionnaire is to furnish information for our files and does not obligate you in
any way, nor does it affect your remaining eligibility.

Name:
(Last) (First) (Middle)

Home Phone:

Home Address: ,
(Street) (City) (ST) (ZIP Code)

Age: Birthdate:
E-mail Address:
Father's Name: Work Phone:
Mother's Name: Work Phone:

High School:
(Name) Graduation Date:
High School Counselor:
GPA

What is your intended college major?

ATHLETIC TRAINING INFORMATION