Program Application

Application for Health Care Careers Exploration Program
For students entering 10th, 11th or 12th grade interested in a career in Health Care.

July 17-21, 2027 Visit Program Site

Interact with deaf, hard-of-hearing, and hearing professionals working in health care and health sciences fields and learn about a variety of health-related careers, including nursing, medical imaging, exercise science, and research. Participate in interactive workshops, simulations, and group projects and gain exposure to career pathways and college majors at RIT/NTID.

Please Note:

We must receive the following required information before we can consider your application.

A copy of your official high school transcript (from ninth to eleventh grade)
A copy of your unaided audiogram (results without a hearing aid or cochlear implant)
An official copy of your ACT/SAT/PSAT scores (optional)
A short essay or paragraph indicating why you want to attend this program and what your long term goals might be in the health care profession
Please note: Students who have attended Health Care Careers Exploration program previously are not eligible to attend again.

Personal

First*

Preferred Name

Last*

Birthdate*

Year of Graduation*

Gender*

Male

Female

Nonbinary

Other

Pronouns Used

He/Him

She/Her

They/Them

Other

Contact

Address*

City*

State*

Zip*

Country

Email*

Phone*

Shirt

Shirt Size*

XXL

3XL

4XL

All shirt sizes are adult sizes

Misc.

Communication Preferences*

Speech & Lipreading (I do not use sign language)

American Sign Language Only

Speech & American Sign Language

Personal

First*

Last*

Duplicate Student Address

Address

City

State

Zip

Country

Email*

Fax

Home*

Work

Cell

Misc.

What language does your family use at home?

School

Name*

Address

City

State

Zip

Country

Counselor

First

Last

Fax

Phone

Teacher

First

Last

Fax

Phone

Additional Information

Please list any known Food Allergies

0/400 characters

If you wish to be identified with a particular ethnic group, please select the appropriate one.

African American, Black

Asian American

Native American, Alaskan Native

Hispanic, Latino

Native Hawaiian, Pacific Islander

White, Caucasian

Other

If you have taken any of the following college entrance tests, please indicate your score in the appropriate box below:

PSAT

PSAT Selection Index (sum of the critical reading, math and writing scores)

SAT

SAT Total score (sum of the critical reading, math and writing scores)

ACT

ACT Composite Score

Are you a Vocational Rehabilitation client?

Yes

How did you first find out about this program?

Received information from RIT/NTID

Saw the advertisement or article in:

Found out about it from my school counselor or teacher

Found out about it from a friend or family member

Read about it online

Other

Please type in the word indicated by the image below:

Application for Health Care Careers Exploration Program
For students entering 10th, 11th or 12th grade interested in a career in Health Care.

July 17-21, 2027 Visit Program Site

Student

Parent/Guardian

Academics

Additional Information

Application for Health Care Careers Exploration Program For students entering 10th, 11th or 12th grade interested in a career in Health Care.

July 17-21, 2027 Visit Program Site

Student

Parent/Guardian

Academics

Additional Information

Application for Health Care Careers Exploration Program
For students entering 10th, 11th or 12th grade interested in a career in Health Care.