Request Health Career Program Information

* fields are required

Are you currently enrolled at Tri-C?: *

YesNo

You do not need to submit this form.

Please complete the Health Careers Get Started Interest Form. (Login with Tri-C student number required.)

First Name: *

Last Name: *

Email: *

Phone: *

Are you a current high school student?: *

YesNo

Name of high school and city: *

Anticipated graduation year: *

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