a total of 1068. This was a sample of convenience by including every NCAA institution in each Division. The subjects that are included were used because of their primary role with pre-participation physical examinations. The subjects that were excluded are certified athletic trainers that are not employed by NCAA Division I, II, and III institutions. Intervention: The subjects completed an electronic survey via email. The email directed the subjects to the website providing the consent by submission of the survey. Each section included demographics, pre-participation examination, medical history, physical examination, and referral. After a two week period a second email was sent encouraging participants to complete the survey. Main Outcome Measures: Based on the responses the majority of NCAA Division I, II, and III institutions performed a cardiac screening within their preparticipation physical examination. NCAA Division I include the majority of medical history and physical examination questions within their cardiovascular screening. Based on the responses NCAA Division III improved the most on implementation of the recommended American Heart Association guidelines within their cardiac screening from the previous study performed in 2000. Results: A total of 327 head certified athletic trainers and director of athletic training services completed the survey responding to cardiovascular screening for a return rate of 33.5 percent. Of those, 103 (31.5%) NCAA Division I, 91 (27.8%) NCAA Division II, and 133 (40.7%) NCAA Division III institutions. The mean score of undergraduate student enrollment was 7562.70 ± 9146.915, student athletes 372.08 ± 173.942, and number of varsity sports was 17.12 ± 14.263. Of the responses a total of 172(52.6%) were aware of the NCAA recommendations with 74(71.8%) Division I, 44(48.4%) Division II, and 54(40.6%) Division III. A total of 322(98.5%) of NCAA institutions perform a cardiovascular screening within their pre-participation physical examination. NCAA institutions that performed yearly pre-participation physical examinations were 186(56.9%). One hundred eighty seven (27.2%) team physicians administered the tests, with 206(63%) v TABLE OF CONTENTS ACKNOWLEDGEMENTS…………………………………………………… iv LIST OF TABLES……………………………………………………………. vi INTRODUCTION…………………………………………………………….