Application

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NOTE - If you are already enrolled in a college-based program, select the school you are affiliated with. Select, "Other" if your school is not in the drop down list.

NOTE - You must live outside of a 60 mile radius to qualify for housing. Housing is available on a first come, first serve basis Housing is only available for those who need clinical hours. Housing does not apply to Fastrack program participants.

Educational Service Requested

Cooperative Education, (COOP), Student
Provider Observation
Service Learning - Highschool Students
Shadowing Program
Healthcare Career Institute
Franklin Learning Center and Lincoln Intermediate Unit
CASHS Learning Support COOP Classes
Non-Clinical hours

* Area of Interest (Limit of 2)

Cardiac Rehab
Cardiovascular Technician
Certified Nursing Assistant
CT Technologist
Echocardiography
Food and Nutrition
Laundry
Medical Assistant
Medical Billing
Medical Coding
Medical Equipment Technologist
Medical Lab Tech
Medical Technologist
Medical Transcription
MRI Technologist
Nuclear Medicine
Nursing
Nutrition/Dietician
Occupational Therapy
Occupational Therapy Assistant
Pharmacy
Phlebotomy
Physical Therapy
Physical Therapy Assistant
Physician's Assistant
Public Relations
Radiation Oncology
Radiology
Respiratory Therapy
Speech Therapy
Sterile Processing
Ultrasound
Unit Secretary
Other
Nurse Practitioner
Physician's Assistant
Facebook
Summit Health Website
Newspaper
Flyer
OPE Representative
Friend
Summit Health Employee
High School or College Guidance Counselor/Advisor
Classroom Presentation
Workshop
Job Fair
Event
Other

Emergency Contact

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NOTE - Fill in address, if different than above