Please complete the form below to submit your application to YMCA Health Careers Achievers Program. Full NameGender male female BirthdatePhone numberStreet addressCityStateZIP codeMailing address (only if different from above) Name of current schoolCurrent GPAGrade entering in August 9th 10th 11th 12th Email address Emergency contact info First and last namePhone numberRelationship to student About you List of extracurricular activities What do you plan to do after high school? Get a job (do not check if you plan to work for the summer) Go to a two-year college Go to a four-year college/university Undecided Other Career interests Athletic Trainer Certified Nursing Assistant Chiropractor Dentist / Dental Hygenist EMT / Paramedic Health Administration Licensed Practical Nurse Medical Assistant Medical Lab Tech Medical Transcriptions Nurse Anesthetist Nurse Practitioner Occupational Therapist Optometrist Pharmacist Pharmacy Technician Physical Therapist Podiatrist Psychologist Radiology Technician Registered Nurse Researcher Respiratory Therapist Ultrasound Technician Veterinarian Other Personal essay Why do you want to attend HealthCare Explorers? What are your future career goals and how do you plan to achieve them? Please answer the following questions in 500 words or fewer. Format does not matter. Because you cannot save and return to this survey later, you may want to type your essay in another program ( such as Microsoft Word) and paste it here. Attendance At this time, are you able to commit to attending these sessions? Yes No If you selected ''No'', please describe the circumstances that will prevent full attendance. Parent / Guardian info Parent / Guardian name (first and last)Cell Phone (include area code)Parent/guardian Email address