Southwestern Oregon Community College

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SOCC Athletic Training Student Application

Athletic Training Inquiry (*required fields)

*The form is only a document noting your interest in the program and in no way constitutes an application for admission to SOCC or an offer of a scholarship at this time.*

First Name*
Last Name*
Address*
City*		State*
Zip*
Phone*
Email Address* (Please enter "none" if you don't have one.)	"MUST be a VALID email address. Do not put in multiple addresses.
Parent's Name
EDUCATION
High School
Date of High School Graduation
Estimated GPA
High School Address
City		State
Zip
Phone
List any high school honors:
ATHLETIC TRAINING EXPERIENCE
Number of years as an athletic training student:
Please list any athletic workshops, clinics, etc. attended during the last two years:
What sports have you worked with, or played?
Will Athletic Training be your primary field of professional endeavor?	Yes No
Briefly explain why you are considering an internship as an Athletic Training Student at Southwestern Oregon Community College. Thank you for your interest in SOCC sports medicine.

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