Name: * APK Specialization:   Athletic Training    Exercise Physiology    Fitness/Wellness  Internship Semester/Year:  Fall Spring Summer Contact Information: Mailing Address: * Phone Number: * E-mail: Emergency Contact/Phone: Will you have any other obligations during your internship that may interfere with scheduling your hours?   Yes       No  Will you be available to attend a required training session during the weekend before your internship starts? *   Yes       No  Do you have transportation?   Yes       No  Do you have any interest in our specialty programs?   Women’s Health    Obesity    Neurological    Cancer Fatigue    Orthopedics  * = Input is required