ANN ARBOR PUBLIC SCHOOLS HEALTH SCIENCES TECHNOLOGY PROGRAM

STUDENT APPLICATION

Name ______________________________________ Date____________________ Address_____________________________Zip_______Email address_________________________ Phone(H)______________(Cell)__________________ Birthdate__________Present Grade__________ Graduating Class_________________Counselor______________________ID#__________________

I would like to be considered for the Health Sciences Program because: _____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________

My career/education plans for the next 3-5 years are: ___________________________________________________________________ ___________________________________________________________________

List any science or health related classes you have taken (i.e. biology,psychology, sports medicine) ____________________________________________________________________

List the number of absences from school you have had this year__________

List your current GPA._______

List and describe any volunteer or paid work you have done at a hospital or health facility. _______________________________________________________________________

If accepted for this program would you be interested in a health related paid co-op job placement? yes_____ no______

Student signature________________________

Return to Huron COE office or Huron general office: attention: Linda Troesch

The Ann Arbor Public Schools does not discriminate on the basis of race, color, sex, religion, creed, political belief, age, national origin,linguistic and language differences, sexual orientation, socioeconomic status, height,weight, marital or familial status or disability.