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									                                                Central Connecticut State University
                                  Department of Physical Education & Human Performance
                                                 Undergraduate Student Application
                                 For Admission into the Athletic Training Education Program

Undergraduate applicants seeking admission to the Athletic Training Education Program are required to submit a file of materials
for review to the Department of Physical Education & Human Performance, Room 018, Kaiser Hall. The applicant’s completed
file should be submitted prior to September 21st or February 21st of the semester in which the student desires to attain eligibility.

Transfer Policy
Transfer students must meet the same course requirements and application procedures as CCSU students. Transfer students are
required to complete a minimum of 15 credits “in residence” at CCSU prior to applying to the professional program. The 15
credits for transfer students may be in General Education and/or within the Athletic Training Education Program and must include
EXS 112 Introduction to Athletic Training and EXS 217 Care & Treatment of Athletic Injuries at CCSU. Currently, all requests
for transfer into the Athletic Training Education Program either by students from other universities or by CCSU students looking
to change majors are handled on a case-by-case basis. The number of students accepted in this manner depends on the number of
openings available in that year. For acceptance into the Athletic Training Education Program, transfer students must complete the
required 200 pre-clinical hours necessary at Central Connecticut State University.

The following are requirements for acceptance into the professional program for Athletic Training:
         1. Completion of an application to the professional program for Athletic Training.
         2. Successful completion of 200 hours in the pre-clinical aspect of Athletic Training at CCSU.
         3. Departmental Requirements for Preliminary Acceptance
                  a. Completion of 45 credits of which a minimum of 15 have been earned at CCSU.
                  b. Successful completion of 3 credits of Human Anatomy (C- or better grade).
                  c. Successful completion of EXS 112 Introduction to Athletic Training and EXS 217 Care & Treatment of
                       Athletic Injuries at CCSU (C- or better grade).
                  d. Successful completion of BMS 380 Emergency Medical Technician and Current State of Connecticut or
                       National Registry EMT-B Certification or higher. (A copy of a current EMT-B certification card must be
                       attached to this application).
                  e. University Grade Point average of 2.50.
                  f. Departmental Grade Point average of 2.50.
                  g. Two letters of recommendation (from persons who can best assess the candidate’s potential).
                  h. The presentation of an essay (500-750 words) demonstrating command of the English language. The essay
                       should include reasons for selecting the B.S. degree program with emphasis on recent experiences relative
                       to Athletic Training. Please provide a word count at the end of the essay.
                  i. An interview with the Screening Committee of the Department of Physical Education and Human
                       Performance, including at least one member of the athletic training faculty and/or clinical instructor.
         Retention Policy
         Once admitted to the professional program, the following requirements must be maintained in order to remain in good
         standing within the Athletic Training Education Program.
                  a. Students must maintain a University Grade Point average of 2.50
                  b. Students must maintain a Departmental Grade Point average of 2.50
                  c. Students must successfully demonstrate all the required skill competencies.
         If a candidate drops below the required GPA levels and/or fails to complete the skill competencies, he or she may be
         denied enrollment to professional program courses, practicum courses and internship assignments until the GPA or
         competencies reach the appropriate level.

         Please Note: Revisions to the athletic training education program may occur in order to maintain compliance with
         national accreditation standards. Students should check with the program director and/or the CCSU athletic training
         education website regarding the possibility of new requirements. All practicum courses and internship assignments
         require the student to be in “good standing” by having both a university and major GPA of 2.50. In addition, all
         practicum courses and internship assignments requires current State of Connecticut or National Registry EMT-B
         Certification or higher.



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                                                   Central Connecticut State University
                                     Department of Physical Education & Human Performance
                                                    Undergraduate Student Application
                                    For Admission into the Athletic Training Education Program

Please Type or Print

Name: _____________________________________________                     CCSU Student ID #: _____________________
                       Last            First           M.I.

Phone: _____________________________                                    Email: ____________________________________

Home Address:                                                           Local Address (if different):
___________________________________________                             ___________________________________________
Street Address                                                          Street Address

___________________________________________                             ___________________________________________
City                                                                    City

___________                   _______________                           ______________           ______________
State                         Zip                                       State                    Zip




I.      Credit Hours Earned: 45 credits must be earned, of which 15 must be “in-residence” at CCSU

            _______ Total Semester Hours Earned at Central Connecticut State University
            _______ Total Semester Hours Transferred


II. Clinical Hours:
        _______ # of Pre Clinical Hours Completed at Time of Application


III. Required Lecture Course Completed:
        EXS 112 Introduction to Athletic Training                ________ Grade           ________ Semester/Year Completed
        EXS 213 Anatomy & Physiology in Human Performance I      ________ Grade           ________ Semester/Year Completed
        EXS 217 Care & Treatment of Athletic Injuries            ________ Grade           ________ Semester/Year Completed
        BMS 380 Emergency Medical Technician                     ________ Grade           ________ Semester/Year Completed

Statement of Health: ____________________________________________________________________________________

______________________________________________________________________________________________________




I, ________________________________ hereby apply for admission to the Athletic Training Education Program at
Central Connecticut State University. I have read and fully understand the requirements for admission and for retention
in the Athletic Training Education Program.


Date: ___________________                      Student’s Signature: _______________________________________




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              Undergraduate Student Application for Admission into the Athletic Training Education Program

_______________________________________________                                                   _____________________________
Student’s Name: Last, First, MI                                                                        CCSU Student ID #

Students Please Do Not Write Below: For Department Screening Committee Use Only


Date Application Received: __________________

I.     Requirements Met:
          45 Credits Earned                                                                                   Yes    No
                   Transfer Students - 15 Credits Earned at CCSU                                              Yes    No
          University GPA 2.50 minimum                                                                         Yes    No
          Departmental GPA 2.50 minimum                                                                       Yes    No
          EXS 112, EXS 213 or 3 credits Human Anatomy, EXS 217, BMS 380 or EMT Course                         Yes    No
          200 Pre-Clinical Hours Completed at CCSU                                                            Yes    No
          Current State of Connecticut or National Registry EMT-B Certification:                              Yes    No

II. Technical Standards:
       Technical Standards Document Signed & Dated:                                                           Yes    No
       Student Is Requesting Accommodations for Technical Standards:                                          Yes    No

III. Essay & Interview:
         Essay Score:                   1.0    1.5     2.0   2.5   3.0                                        Pass   Fail
         Interview Score:               1.0    1.5     2.0   2.5   3.0                                        Pass   Fail

Acceptance:
          □    Approved: Date _________________

          □    Deferred: ________________________________________________________________________________

          □    Rejected: ________________________________________________________________________________

___________________________________                          ___________________________________                     __________
Chair’s Name Printed                                                       Chair’s Signature                              Date

___________________________________                          ___________________________________                     __________
Printed Name – AT Faculty and/or Clinical Instructor                          Signature                                   Date

___________________________________                          ___________________________________                     __________
Printed Name – Committee Member in Attendance                                 Signature                                   Date


                                   Please attach BOTH sides of current EMT Card in the Space Provided Below




                       Front Side of Current EMT Card
                                                                                               Back Side of Current EMT Card




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                                                    Central Connecticut State University
                                      Department of Physical Education & Human Performance
                                                     Undergraduate Student Application
                                     For Admission into the Athletic Training Education Program

The Athletic Training Educational Program at Central Connecticut State University is a rigorous and intense 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 Athletic Training Educational Program establish the essential qualities considered necessary
for students admitted to this program to achieve the knowledge, skills, and competencies of an entry-level athletic trainer, as well
as meet the expectations of the program's accrediting agency (Commission on Accreditation of Athletic Training Education
[CAATE]). All students admitted to the professional program in the Athletic Training must meet the following abilities and
expectations. In the event a student is unable to fulfill these technical standards, the student will not be admitted into the program.
Compliance with the program’s technical standards does not guarantee a student’s eligibility for the BOC certification exam.

Candidates for admission to the professional program in Athletic Training at CCSU must demonstrate:
  1. The demonstrated ability 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. Evidence of sufficient postural and neuromuscular control, sensory function, and coordination to perform appropriate
      physical examinations using accepted techniques; and the demonstrated ability to accurately, safely and efficiently use
      equipment and materials during the assessment and treatment of patients.
  3. The demonstrated 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, ability to maintain a professional
      demeanor, 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 demonstrated ability to record the physical examination results and a treatment plan clearly and accurately.
  5. The demonstrated ability to maintain composure and continue to function effectively during periods of high stress.
  6. The perseverance, diligence and commitment to complete the athletic training education program as outlined and sequenced.
  7. Demonstration of flexibility and ability to adjust to changing situations and uncertainty in clinical situations.
  8. The demonstrated ability to perform the affective skills that relate to professional education and quality patient care.

Candidates for admission to the professional program in athletic training 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. A student who believes that
they have a disability that may impact admission to or successful completion of this program should contact the CCSU Office of
Student Disability Services. The Office is located in Copernicus 241, Phone (860) 832-1900, TTY: (860) 832 - 1954,
http://www.ccsu.edu/learnctr/disability/default.html. The Office of Student Disability Services will evaluate the student’s
documentation to determine if the stated condition qualifies as a disability under applicable laws and so notify the Program Director
of Athletic Training Education Program and the Chair of the Department of Physical Education & Human Performance.

If a student with a qualified disability states he/she can meet the technical standards with accommodation, then the student and
appropriate University personnel will discuss what accommodation(s) may be effective and whether the accommodations
requested are reasonable, taking into account clinician/patient safety, and whether the requested accommodations would
fundamentally alter the nature of the program, including academic standards.

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. I understand that if I am unable to meet these standards I will not be admitted into
the program.



______________________________                  __________________________________                    ____________
       Printed Name                                 Signature of Applicant                                Date

Approved by University Counsel 3/10/03




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                                                    Central Connecticut State University
                                      Department of Physical Education & Human Performance
                                                     Undergraduate Student Application
                                     For Admission into the Athletic Training Education Program




                  TECHNICAL STANDARED FOR ADMISSION INTO THE PROFESSIONAL PROGRAM




                                    Alternate Statement for Students 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 with certain accommodations. I will contact the CCSU Office of Student Disability
Services. The Office is located in Copernicus 241, Phone (860) 832-1900, TTY: (860) 832 - 1954,
http://www.ccsu.edu/learnctr/disability/default.html. 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.


______________________________                  __________________________________                ____________
       Printed Name                                 Signature of Applicant                            Date




Approved by University Counsel 3/10/03



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