Cardiology Online Interest
Thank you for expressing interest in an online version of the Cardiology Course.  

The purpose of this form is to gauge interest in this course being offered in a virtual format and to determine the best dates and time zones for it to be offered.  Families who enter their information here will be notified if a course fitting their preferences is offered.  
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Parent Name
Parent Email address
Parent Phone Number
Student Name
Student grade in Fall of 2020
In which time zone do you live?
If Cardiology were offered during a week you were available in the summer how interested would you be in enrolling?
Mildly Interested
Extremely Interested
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During which weeks would your child potentially be available?
Comments or Questions
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