Health Career Session Participation Form

This form is not an application to a health career program. This participation form must be completed, signed, and submitted upon finishing today’s Health Career Session. Your participation fulfills one of the program admissions requirements necessary to qualify for the health career program which you applied to.

First

Last

QCC ID

I am a

Date of Birth

Phone

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Agreement

Please initial each statement

By signing this form, I acknowledge that I have read and understand the entire Health Careers Session information. By so doing, I understand that I have met the “Attend Health Career Session” program admissions requirement

It is my responsibility to meet all of the program admissions requirements for the health career of my choice. I understand the program requirements and the process are subject to change.

I agree that I am responsible for all information within. Specifically, I understand that some programs may have additional admissions requirements and/or have a waitlist

Signature

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