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Athletic Training Questionnaire

If you are interested in being considered for an athletic training scholarship at Coffeyville Community College, please fill out the form below.  Information from this form will be submitted directly to the CCC Athletic Training Staff.

Name:

Home Telephone:

Home Address:

City:  State:  Zip:

Parent's (Guardian's) Name:

Email:

High School:

High School Telephone:

Date of Graduation: Grade Point Average:

Class Rank:  Out of Total:

ACT Score:  SAT Score:

Have you ever attended an athletic training workshop? Yes  No

If so, when?

Are you, or have you been, certified in:  First Aid Yes No         CPR Yes No

What is/are you planned major(s): 1.  2.

Other Schools you are considering: