Lincoln Memorial University School of Allied Health Sciences Department of Athletic Training Application Deadline: Monday, April 6, 2015 Athletic Training Program Practicum Phase Application PERSONAL DATA I am applying for the Fall Term. Name: Gender: M or F ID # : Last First MI Date of Birth: Permanent Address: Street City State Zip Local Address: Street City State Zip Phone #: Cell #: E-mail: PRE-REQUISITES Copies of transcripts are required from all colleges as proof of attendance and grades. Use IP (in progress) if you are currently enrolled. All pre-requisites must be completed prior to the start of the program. COURSE # COURSE NAME CREDITS WHEN & WHERE TAKEN GRADE ATTR 100 Foundations of Athletic Training 3 ATTR 102 Clinical Intro to Athletic Training 1 ATTR 170 Musculoskeletal Anatomy 3 ATTR 170L Musculoskeletal Anatomy Lab 1 EDUCATION Please check any of the following that apply: I am currently enrolled at Lincoln Memorial University. I am not currently enrolled at Lincoln Memorial University, but I have been admitted as a transfer student for the Term Year I am a licensed or certified health care professional: Title License/Certification # Page 1
SCHOOLS ATTENDED HIGH SCHOOL ATTENDED ACT/SAT SCORE GPA ACTIVITIES/ HONORS COLLEGES ATTENDED MAJOR GPA YEARS ATTENDED ACTIVITIES/ HONORS CRIMINAL BACKGROUND CHECK The Athletic Training Program may require candidates to submit to criminal background checks as a part of placement in clinical rotations. Misdemeanor or felony records may prevent placement at clinical sites and may prevent eligibility to take certification examinations. Applicants should fully disclose any form of criminal record regardless of legal outcome. Please answer the following: 1. I have been charged or convicted of a misdemeanor or felony. Yes No 2. I ve had adjudication withheld on a misdemeanor or felony. Yes No 3. I ve been found in violation of student conduct (including academic conduct) at any college or university. Yes No 4. I understand that criminal backgrounds checks and/or fingerprinting will be required for placement at some practicum sites and that I am responsible for any cost incurred during the background check. Yes No 5. I agree to notify the Athletic Training Program immediately regarding any changes to my criminal or academic background. Yes No If you answered yes to statements 1 3, or are unsure, please attach a statement of explanation, including all relevant facts and documentation, to this form. You may be required to furnish the university with copies of all official documentation explaining the final disposition of the proceedings. If you have questions or concerns about this requirement, please contact the ATP Director so that your needs and career aspirations can be fully evaluated. Failure to answer these questions will delay the processing of your application. Page 2
ATHLETIC TRAINING EXPERIENCE & OBSERVATION HOURS Do you have any previous experience as an athletic training student? If so: High School College Other Additional athletic training experience (workshops, clinics, summer teams, etc.): Are you presently a member of the National Athletic Trainers Association or of any related associations? If so, please list: If you completed your observational hours somewhere other LMU, please list the location(s) where you completed your 80 hours of clinical experience, the total hours observed at that location, and the name(s) of the ATC observed. ATC Name: Location: Total # hours: General description of observed activities: I certify that the information given in this application is complete and accurate, and I understand that making false or fraudulent statements within this application may result in disciplinary action, denial of admission and invalidation of credits or degrees earned. Applicant Signature: Date: Page 3
REVIEW OF TECHNICAL STANDARDS The Athletic Training Program (ATP) at Lincoln Memorial University is a rigorous and intense academic program that places specific requirements and demands on the students enrolled in the program. An objective of this program is to prepare graduates to enter a variety of employment settings and to render care to a wide spectrum of individuals engaged in physical activity. The technical standards set forth by the ATP establish the essential qualities considered necessary for students admitted to this program to achieve the knowledge, skills, and competencies of an entrylevel athletic trainer, as well as meet the expectations of the program s accrediting agency, the Commission on Accreditation of Athletic Training Education (caate). All students admitted to the ATP must at all times while enrolled in the program meet the requirements for the following abilities and skills. While enrolled, if a student becomes unable to meet the technical standards of the ATP, it is the responsibility of the student to notify the ATP director, at which time the student will be referred to the University s ADA coordinator. If the student is unable to meet the technical standards, with or without reasonable accommodation, the student will not be allowed to continue to participate in the program. Lincoln Memorial University is committed to the principle that no qualified individual with a disability shall, on the basis of disability, be excluded from participation in or denied the benefits of the services, programs, or activities of the University, or be subjected to discrimination by the University as required by the Americans with Disabilities Act of 1990. However, Lincoln Memorial University cannot and does not waive the published degree requirements for ATP students. Lincoln Memorial University will make a reasonable accommodation to assist otherwise qualified individuals with disabilities to fulfill their degree requirements, consistent with applicable federal and state law and the policies of Lincoln Memorial University. In the event a candidate is unable to fulfill these technical standards, with or without reasonable accommodation, the candidate will not be admitted into the program. Candidates for selection to the Athletic Training Program must demonstrate: 1. The mental capacity to assimilate, analyze, synthesize, integrate concepts and problem solve to formulate assessment and therapeutic judgments and to be able to distinguish deviations from the norm; 2. Sufficient postural and neuromuscular control, sensory function, and coordination to perform appropriate physical examinations using accepted techniques; and accurately, safely and efficiently use equipment and materials during the assessment and treatment of patients; 3. The ability to communicate effectively and sensitively with patients and colleagues, including individuals from different cultural and social backgrounds; this includes, but is not limited to, the ability to establish rapport with patients and communicate judgments and treatment information effectively. Students must be able to understand and speak the English language at a level consistent with competent professional practice; 4. The ability to record the physical examination results and a treatment plan clearly and accurately; 5. The capacity to maintain composure and continue to function well during periods of high stress; 6. The perseverance, diligence and commitment to complete the athletic training education program as outlined and sequenced; 7. Flexibility and the ability to adjust to changing situations and uncertainty in clinical situations; 8. Affective skills and appropriate demeanor and rapport that relate to professional education and quality patient care. Page 4
Mastery of these technical standards must be demonstrated by the ability to perform the following list of physical, cognitive, psychomotor, and affective skills during didactic, laboratory, and clinical education in Athletic Training. A. Visual Acuity Ability to see all colors of the spectrum Ability to distinguish calibrated markers Ability to identify digital displays and controls in differing lighted environments Ability to determine the depth of instrument placement Ability to read small print on medical instrumentation or containers B. Hearing Acuity Ability to hear alarms, beeper, and pages Ability to hear and respond to verbal communication in the work setting Ability to distinguish different alarm sounds/tones on medical devices C. Physical Acuity Ability to perform all ranges of body motions including walking, bending, stretching, reaching, and twisting of the upper and lower back. Ability to lift 35 pounds (weight of small child or small equipment) alone Ability to stand and/or sit for long periods of time Ability to perform CPR; use of hands for manually compressing resuscitation equipment, and the use of hands and body for performing chest compressions Ability to write legible for required documentation Ability to move swiftly when the situation demands D. Communication Ability to communicate with physicians, coaches, co-workers, other health care workers, the athlete and the athlete s family E. Mental Stress Ability to function appropriately under stress without hesitations using all knowledge and skills require to perform the task at hand Ability to work long hours (8 to 12 hours), adapting to changes in the clinical schedule and/or emergency situations Ability to function as a team member and to follow the appropriate administrative protocol and/or chain of command Ability to review and use student-athlete data in a confidential and professional manner Ability to make quick, lifesaving decisions F. Clinical Behavior Requirements Must be patient, kind, and tactful in dealing with athletes and their families Must understand that all information obtained in the clinical facilities is strictly confidential and it is not to be discussed outside the athletic training room Must attend clinical experiences as required. Page 5
Compliance with the program s technical standards does not guarantee a student s eligibility for the BOC certification exam. Candidates for selection to the ATP will be required to verify they understand and meet these technical standards or that they believe that, with certain accommodations, they can meet the standards. The Athletic Training Program will refer candidates for selection requesting accommodations to the University s ADA Coordinator If a student states he/she can meet the technical standards with accommodation, then the ADA Coordinator in conjunction with the ATP Director will determine whether the student can meet the technical standards with reasonable accommodation. Reasonable accommodations must take into account whether accommodation would jeopardize clinician/patient safety, or the educational process of the student or the institution, including all coursework, clinical experiences and internships/externships deemed essential to graduation. PLEASE SIGN ONLY THE APPROPRIATE SPACE BELOW REGARDING THESE TECHNICAL STANDARDS Statement for students NOT requesting accommodations I certify that I have read and understand the technical standards for selection listed above, and I believe to the best of my knowledge that I meet each of these standards without accommodation. I understand that if I am unable to meet these standards I will not be admitted into the program. Applicant Signature: Date: Alternative statement for student requesting accommodations I certify that I have read and understand the technical standards of selection listed above and I believe to the best of my knowledge that I can meet each of these standards with certain accommodations. I will contact the ADA Coordinator to determine what accommodations may be available. I understand that if I am unable to meet these standards with or without accommodations, I will not be admitted into the program. Applicant Signature: Date: Page 6
ESSAY Essays are evaluated on quality, not quantity of the material. Each question should be typed in essay format and be no more than 100 words. 1. Describe your understanding of the role of an athletic trainer in healthcare. 2. Why do you want to become a certified athletic trainer? 3. Describe your personal attributes that you feel are directly related to being successful in the profession of athletic training. 4. How would you evaluate your time management, organizational skills and work ethic? 5. What are your primary career goals upon graduation of Lincoln Memorial University? 6. Identify three things that you have learned through your clinical observation hours that have enhanced your commitment to pursuing acceptance into the Athletic Training Education Program. 7. Any other information that you feel will enhance your application and is pertinent to athletic training or your academic studies. Completed applications should be returned to: Whitney Bailey, MEd, ATC, LAT Chair, ATP Admissions Committee Department of Athletic Training 6965 Cumberland Gap Parkway Harrogate, TN 37752 Phone: (423) 869-6826 Fax: (423) 869-6846 E-mail: whitney.bailey2@lmunet.edu APPLICATION CHECKLIST Please include the following items with your application: Completed Application Form including signed Technical Standards Form. o The inability to meet the technical standards requires further consultation with the ATP Director to evaluate your personal situation. Student disability is not a factor in the evaluation of applications. Transcripts (unofficial) from ALL colleges you have attended Copy of your current CPR card (AHA Healthcare Provider or ARC Professional Rescuer) Copy of your current First Aid card (AHA HeartSaver First Aid or ARC First Aid) Three letters of recommendation (include with application in sealed envelope OR mail directly) o Instructor (highlighting classroom performance) o Character Reference (non-family member) o Previous supervisor (ATC, coach, employer) Completed Essays Any documentation that may be required regarding your criminal or academic background (If applicable) Any documentation of hours from previous collegiate athletic training experiences outside of Lincoln Memorial University (If applicable) Page 7