Health Careers
Summer Enhancement Program
June 21 –
6th & W Streets NW, Annex II, Room 104
Application
Deadline:
Please type or print
Name: Telephone
( ) e-mail
Address: City: State: ZIP
School: Date
of Graduation:
Social Security # Date
of Birth: Age: Gender: M/F
Circle One
Student
Signature: Parent/Guardian
Signature:
*
·
I certify that all of the information on this application is current.
If accepted into the program, I give HCOP permission to track my academic
progress for grant reporting purposes.
Ethnicity: Check One
___African-American ___American Indian/Alaskan Native
___Asian ___Hispanic/Latino
___Native Hawaiian/Pacific Islander ___White __________
Other (Please Specify)
Citizen Eligibility: Check One
___US
Citizen ___Permanent
Resident
Academic Background: Overall GPA______
SAT: (High
School Academy
Family Background: Check One
Father’s
Highest Level of Education Obtained:
Mother’s
Highest Level of Education Obtained:
Family
Income: ________ Is English the primary language? ___Yes ___No
Please Include:
- A copy of recent
transcript
- A double- spaced and
TYPED 250-350 word statement describing why you want to participate in the
program, explaining why you are a desirable candidate and how you will
contribute to HCOP and the Allied Health Field. Please feel free to
include all extracurricular activities.
- A current resume
- Two letters of
recommendation: One from a guidance
counselor (mandatory); One from an adult that is
familiar with your academic, professional, and ethical background. For
example, a teacher or employer; no friends or family.
Your
application will not be complete without these items. Further, if the statement
is not typed, your application will not be considered for the program. Return completed application by________
Mrs.
Robyn Hart—Program Coordinator—
Health Careers
6th & W Streets, Annex II, Room 104
Office
Use Only: __HS __HBCU __CJC