Athletic Trainer

GCIT Athletic Training Department Mission Statement

The GCIT Athletic Training Department is dedicated to providing the highest standard of care for all student-athletes. Our mission is to ensure the health, safety, and well-being of every participant through prevention, evaluation, treatment, and rehabilitation of athletic injuries. We strive to educate athletes on proper health practices, support peak performance, and foster a safe environment where students can achieve their full potential.

Athletic Training Dept. - Document Request Form

Athletic Training Dept. - Document Request Form

Required

Purpose:
This form is for student-athletes, parents/guardians, and coaches requesting documentation from the GCIT Athletic Training Department. Please allow 3–5 business days for processing. You will receive an email when your request is complete.

Requestor Information:

Namerequired

First Name

Last Name

Email Addressrequired

Phone Number

Role/Relationship to Athleterequired

Student-Athlete Information:

Namerequired

First Name

Last Name

Sport(s)required

Graduation Yearrequired

Date of Birthrequired

Must contain a date in M/D/YYYY format

Documents Requested:

Please select the document(s) you are requestingrequired

Injury Report / Evaluation Summary

Treatment or Rehabilitation Record

Concussion Baseline Test

Return-to-Play Documentation

Copy of School Insurance Form Regarding Injury

Reason for Request:

Reason for Request

(Example: “Need copy for college recruiter,” “For personal record,” “Doctor’s office requested docum

Additional Comments or Instructions:

Additional Comments

Agknowlegdement:

Terms of Servicerequired

By submitting this form, I acknowledge that I am authorized to request this information and that I understand certain medical or confidential records may only be released in compliance with HIPAA and FERPA regulations.

Digital Signaturerequired

First Name

Last Name

Daterequired

Must contain a date in M/D/YYYY format

Kelli Swanson

Athletic Trainer

School: 856-468-1445 ext. 2661

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GLOUCESTER COUNTY INSTITUTE OF TECHNOLOGY

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Athletic Trainer

GCIT Athletic Training Department Mission Statement

Athletic Training Dept. - Document Request Form

Kelli Swanson

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