Athletic Training Residency Program Application

Admission Requirements

Qualifications
-NPI number.
-Eligible for Athletic Training Licensure in the State of Alabama.
-BOC Certification.
-Bachelor’s degree required.
-Master’s degree preferred or 5 years of post-certification athletic training experience in lieu of
master’s degree.
-Two years’ experience as a Certified Athletic Trainer (preferred).
-Current CPR/AED training from a BOC approved Emergency Cardiac Care Program.
-Background check and drug screening will be completed by Ascension St. Vincent’s.

Application Checklist

APPLICATION IS NOT COMPLETE WITHOUT ALL SUPPORTING DOCUMENTATION
-Cover letter.
-Resume/Curriculum Vitae.
-Completed application.
-Proof of CPR/AED Certification completed through the American Heart Association.
-Three current letters of recommendation, including one letter from previous Athletic Training Education Program Director.
-Proof of COVID-19 and Influenza vaccination (required by Ascension St. Vincent’s). Medical or religious exemption for either or both vaccines may be submitted for review.
-$25 non-refundable application fee made payable to ASMI.

Applications will be accepted from November 1 ,2023 through March 1, 2024.

Interviews for the applicants will begin within 14 days of close of application acceptance with an initial phone interview followed by a more in-depth virtual interview.`

The applicant selected for the residency will be notified within 7 days after interview and will be given 7 days to reply to the offer

The residency training will begin in late July or early August 2024.

If you have any questions, please email info@asmi.org

Please submit this application and all supporting documentation along with a
$25.00 non-refundable application fee to:

ATTN Jenny Degnan / Chris King email at info@asmi.org

ASMI and the R.T. Floyd Athletic Training Residency would like to offer a special thank you to Dr. James Andrews for his guidance and support in bringing this AT Residency to fruition. His undeniable support for the profession of Athletic Training is evident here in this program.

Personal Information

Name(Required)

First Last

Current Email Address(Required)

Current Phone Number(Required)

Current Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Permanent Home Address (if different)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Drivers License Information

Issuing State(Required)

Current & Valid(Required)

Yes

High School Information

High School Name(Required)

Graduation Date(Required)

High School Location(Required)

City, State

College Information

College Name(Required)

Graduation Date(Required)

Location(Required)

City, State

Major(Required)

Minor(Required)

Degree(Required)

GPA(Required)

Additional College Information (if needed)

College Name

Graduation Date

Location

City, State

Major

Minor

Degree

GPA

Certifications & Licensures

ATC BOC Certification Number

Expiration Date

AHA CPR/AED Certification Number

Expiration Date

Athletic Training License Number

Issuing State

Expiration Date

Athletic Training NPI Number

Expiration Date

Other Certifications & Licensures

Organization

Certification/License Number

Expiration Date

Organization

Certification/License Number

Expiration Date

Previous Athletic Training Employment & Experience

Name of Company/Institution

Start Date

End Date

Job Title

Supervisor

Job Duties

Previous Athletic Training Employment & Experience (cont)

Name of Company/Institution

Start Date

End Date

Job Title

Supervisor

Job Duties

Previous Athletic Training Employment & Experience (cont)

Name of Company/Institution

Start Date

End Date

Job Title

Supervisor

Job Duties

Any additional Athletic Training Activities/Experience:

Non-Athletic Training Work Experience

Company/Institution

Start Date

End Date

Job Title

Supervisor

Job Duties

Non-Athletic Training Work Experience (cont)

Company/Institution

Start Date

End Date

Job Title

Supervisor

Job Duties

Non-Athletic Training Work Experience (cont)

Company/Institution

Start Date

End Date

Job Title

Supervisor

Job Duties

Essays

How did you learn about the R.T. Floyd ASMI Athletic Training Residency Program?(Required)

Have you taken an active part in any scientific research projects? If so, what was the nature of your involvement?(Required)

Why are you interested in participating in the R.T. Floyd ASMI Athletic Training Residency Program?(Required)

What do you hope to gain from this 12-month Athletic Training Residency experience?(Required)

What are your strengths and weaknesses?(Required)

I certify that the information in this application is true and complete to the best of my knowledge and I understand that inaccurate information may affect my acceptance into this program. I agree to provide, if requested, documentation necessary to verify information reported on this form, I also give permission for NHMI to contact my previous employers

Initials(Required)

Signed

Date(Required)

Application Fee

Price:

Total

Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

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