Nursing Academy Signup | CAMC Health System

Student First Name

Student Last Name

Student Date of Birth

Students Age

High School

Students Grade

Student Current Overall GPA

Student email address

Student phone number

Parent / Legal Guardian name

Phone number (Parent)

Email Address (Parent)

Email Address (to use for future communications regarding program)

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Do you have a parent/guardian who is currently a CAMC Employee?

Yes

If yes, CAMC Parent/guardian name

How did you hear about this opportunity

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Summary of Interest (1000 character limit)

Have you participated in this program before?

Yes

If Yes, What year?

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