Health Science Career Day

Register

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

Indicates all required fields
First Name:
Last Name:
Email:
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Phone:   xxx-xxx-xxxx
Birthdate:
Your birthdate should be entered as mm/dd/yyyy.
Street Address:
City:
State/Province:
Postal Code:
School:
Graduation Year:
Track E Track F
Occupational Therapy Social Work
Prosthetics Dietary
Optometry Speech Pathology
Choice Chiropractor
OR/Surgical Tech Lab Technician
Pharmacy Choice
Cardiac Rehab. Audiology

Note: Tracks A, B, C, D, G and H are now full. Tracks are limited to 30 students each. Every effort will be made to place you in one of your top three choices.
First Choice:
Second Choice: (Choose a different track than First Choice)
Third Choice: (Choose a different track than First or Second Choice)

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