Health & Wellness Career Day

Register

Please fill out the form to register for the Health & Wellness Career Day.

Please correct the following errors:

Name:

First Name

Last Name

Date of Birth:

High School:

Please enter the name of the High School you attended (or are attending).

Graduation Year:

Please enter your High School graduation year.

Email:

Phone:

Address:

Street/Mailing Address

City

State

Zip/Postal Code

Area of Interest

(Rank each from 1 to 6, with 1 being your first choice)

Nursing

Physical Therapist Assistant (PTA)

Health Information Management Systems (HIMS)

Paramedic/EMS

Allied Health (Nurse Aide/Medication Aide)

Health, Physical Education & Recreation (Athletic Training, Exercise Science, Personal Training, PE/Teacher Education, Pre-Dietetics)

T-Shirt Size: