ATEP Application for Admission - College of Health

ATEP Application for Admission
University of Utah
CAATE Accredited
Deliver application and materials to:
Athletic Training Education Program
c/o Josh Larson, Manager
Department of Exercise and Sport Science
1850 E. 250 S., HPR N 247
Salt Lake City, UT 84112
Full Name:
Mailing Address:
U of U Email:
List in chronological order all colleges attended: please use additional paper, if necessary. (An official transcript
is needed for prerequisite work that was taken at any institution other than the University of Utah.)
Name of Institution:
Dates of Enrollment:
Name of Institution:
Dates of Enrollment:
U of U Cumulative GPA
# of Semesters completed at the U __________
Total Credit Hours Completed at the U
Are you currently using or have you ever used any drugs (including recreational drugs) without a valid
prescription, the possession or distribution of which is unlawful under the Utah Controlled Substances Act or
other applicable state or federal law?
Have you pled guilty to, no contest to, or been convicted of a misdemeanor in any jurisdiction within the
past ten (10) years? Motor vehicle offenses such as driving while impaired or intoxicated must be disclosed but
minor traffic offenses such as parking or speeding violations need not be listed.
If you answered “yes” to any question above, you must submit a complete narrative of the circumstances that
occurred for EACH and EVERY conviction, plea in abeyance, and/or deferred sentence. You must also attach
copies of all applicable police report(s), court record(s), and probation/parole officer report(s). Also enclose with
this application complete information with respect to all circumstances and the final result, if such has been
If you are unable to obtain any of the records required above, you must submit documentation on official
letterhead from the police department and/or court indicating that the information is no longer available. If you
have formally expunged a criminal record as evidenced by a court order signed by a judge, you do not need to
disclose that criminal history.
As an applicant for the Athletic Training Education Program offered at the University of Utah, I do
hereby verify that all of the above listed information is true. I further understand that any omission or
misrepresentation of any part of the application information is grounds for immediate dismissal if I am
accepted into the program. I ac knowledge and accept the fact that my failure to submit a transcript by
the beginning of the Spring semester showing completion of required courses listed above currently
being completed will result in my being dismissed from the program.
Signature _______________
The University of Utah Department of Exercise & Sport Science seeks to provide equal access to its programs,
services and activities for people with disabilities. Reasonable prior notice is needed to arrange accommodations.
Valid Thru 11/1/2014