Rural High School Medical "Camp"
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DEADLINE TO APPLY IS MARCH 15

Instructions: Applications are only accepted online. All questions must be answered, except where noted.

Student Application for Rural High School Medical "Camp"

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All correspondence will be through this e-mail address.
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*Please give us permission to share your email address with the other participants.
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*Please give us permission to publish pictures taken during the 'Camp' that include you.
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*T-Shirt Size (Men's):
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Gender

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Race/Ethnicity (indicate all that apply):
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*Current Grade:
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*As a high school student, would you say you make mostly:
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*Guidance Counselor/Health Sciences Instructor E-Mail Address:
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