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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.







Facebook
Summit Health Website
Newspaper
Flyer
School Liason/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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Address if different than above