Outside Employment Notification Form
To be submitted to Clinical Coordinator Karen Straub, ATC for approval and subsequently filed in requesting student’s permanent folder.
Name: / Student #:
Current GPA: / Current extracurricular activities:
I realize that as an athletic training student I am expected to be present and active in all assigned academic and clinical roles as part of my overall education and that failure to do so compromises my educational experience. I further realize that I may be allowed to hold part time jobs outside of the ATEP only if the job does not interfere in any way with my assigned responsibilities as determined by the ATEP staff. Having reviewed my clinical assignment for the current semester and my part time employment opportunities, I am requesting advance approval to obtain employment outside of the Athletic Training Education Program as detailed below. In making this request, I am also aware that approval of this request does not release me from assigned classes or clinical education experiences except as approved below. I further understand that approval of this form is only good for the employment as detailed below for the current semester and that should my employment opportunities change or continue for future semesters I will need to submit a new Outside Employment Notification Form.
Employer: / Telephone:
Address / City / State / Zip
Employment expected to begin on / and continue until
month/day/year / month/day/year
Specify a.m. & p.m. / Sun / Mon / Tue / Wed / Thu / Fri / Sat
Time needed to depart UWA for work
Time expected to be available at UWA for clinical assignment
Specify in the space below any further details regarding employment hours not included in the above schedule, particularly if the times or days may vary from week to week:
Current Clinical Assignments: / Date Submitted:
Requesting ATS Signature: / Date:
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Date Received:
Approved as requested / on
Approved with exceptions as listed below: / on
Exceptions: / 1. 
2. 
3.