24-25 Health Occupations Student Registration
Students who have been accepted into the health occupations program for Fall 2024 should complete the below form after they have watched the Orientation Session/Video.  Your teacher and/or the Program Director will email you over the summer.  By registering below, you give permission for our office to contact you and a parent regarding class.
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Student Email Address- please use an email not given to you by your school. *
Student First Name *
Student Last Name *
Your Grade Level this Fall *
Your High School *
Do you have an IEP?  (your answer will be kept confidential)
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Student Cell Phone Number xxx-xxx-xxxx *
Street Address *
City *
State *
Zip Code
Parent/Guardian Name (First and Last)
A Parent Phone Number
A Parent Email
What are your career goals related to the program?
What do you hope to gain from participation in the program?
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