CATA Penny F. Dunker-Polek Scholarship The Connecticut Athletic ...

CATA Penny F. Dunker-Polek ScholarshipThe Connecticut Athletic Trainers’ Association is pleased to announce that applications are now beingaccepted for the inaugural CATA Penny F. Dunker-Polek Scholarship. This is a $1000 scholarship thatwill be awarded at the 2010 CATA Symposium. The CATA Penny F. Dunker-Polek Scholarship wasestablished by the CATA and Penny’s family, friends and colleagues to honor her memory. Penny waswell-known for her enthusiasm, unfailing work ethic, and unselfish desire and willingness to help peoplein any way she could. She consistently maintained an “above and beyond” attitude both in the field, in theacademic setting, and in her overall outlook on life. Penny was strongly involved in the community, withinvolvement in numerous activities including tutoring, and teaching first aid and CPR. The recipient ofthis award should demonstrate similar qualities.Eligibility Requirements• Applicant must be a member of the NATA.• Applicant must be a full-time undergraduate student enrolled in an accredited Athletic TrainingEducation Program in Connecticut.• Applicant must have academic standing as a junior or senior (including 5 th year).• Applicant must demonstrate an “above and beyond” attitude both as an athletic training student inthe field and academically, as well as in other activities in which he or she may be involved.• Applicant must have a demonstrated commitment to the profession.• Applicant must be in good standing academically in accordance with the requirements of his/herAthletic Training Education Program. There is no other minimum GPA requirement for thisscholarship.• Applicant must confirm his/her intent to pursue the athletic training profession as his/her primarymeans of livelihood.1

CATA Penny Dunker-Polek Scholarship ApplicationNOTE: This application will make the applicant eligible only for the CATA Penny F. Dunker-Polek Scholarship.Name ________________________________________________________Date________________________(last) (first) (middle)College or University _______________________________________________________________________School Address ____________________________________________________________________________(street) (city) (state) (zip)Home Address ____________________________________________________________________________(street) (city) (state) (zip)Home Phone___________________________ School/Cell Phone ___________________________Current Class Standing: Junior_____ Senior_____ Email: __________________________________Major __________________________________Minor__________________________________Are you currently completing clinical experiences as an athletic training student? Yes_____ No_____How many hours of athletic training experience have you gained under a licensed athletic trainer? ______How many semesters of clinical experience have you had as an athletic training student? ___________NATA member # ___________________How many years have you been a NATA member? ____________Are you currently a member of the Connecticut Athletic Trainers Association? Yes______ No _______How many years have you been a CATA member? __________Are you currently planning to make athletic training your primary field of professional endeavor after graduation?Yes _______ No _______I hereby confirm that all of the foregoing information is true and correct.Applicant’s Signature: ______________________________________________Date: ______________Print Name: ______________________________________________________3

CATA Penny Dunker-Polek Scholarship Application (continued)ACTIVITY PARTICIPATIONDescribe any activities in which you participate (organizations, clubs, etc.), including leadershippositions.List any volunteer or community service activities in which you have been involved in over the course ofyour college career, including leadership positions.List any honors, awards or other special recognition you have received during your college career. Includeacademic, departmental, athletic training, volunteer and other community service awards.List any experience you have had in athletic training.Briefly describe (in 1 page or less) why you feel you are deserving of the Penny Dunker-PolekScholarship. (Please attach a separate page, with your name typed at the top).4

Affidavit of EnrollmentCATA Penny Dunker-Polek Scholarshipto be completed by the ATEP Program DirectorApplicant’s Name: _____________________________________________________________(Last) (First) (Middle)Name of Institution: ____________________________________________________________Degree Program: ______________________________________________________________Major: __________________________________Minor: ____________________________Credit Hours required for Graduation: ________ Credit Hours Completed: _________Expected Completion Date of Undergraduate Degree: _________________Does this student currently meet all criteria for retention in your program? Yes _____ No ______I certify that the above applicant is enrolled at our institution, is in good academic standing within the Athletic TrainingEducation Program, and that the foregoing information is correct.Signature: _______________________________________________ Date:_________________Name and Title: _______________________________________________________________5