NH Health Care Month Registration
From Nurses to pharmacists, from physical therapists to home health care aids, from medical office managers to occupational therapy assistants and everything in between, the health care industry has something for everyone. The opportunities are endless and the career opportunities offer many benefits. During NH Health Care Month visits, students will have the opportunity to get a behind the scenes look at day-to-day operations, interact with employees to hear about their career pathway, and learn about a day in the life of a health care professional. Additionally, they will broaden their knowledge of what other career opportunities relate to all aspects of the industry supporting health care operations and management.

The first annual NH Health Care Month will occur May 1st through May 25th, 2018. This form is intended to gather interest from New Hampshire schools in order to match up schools with local health care partners. Requests are not guaranteed, but every attempt will be made to accommodate. Each school may preregister for a group of up to 25 students. This event is targeted at middle school and high school students.

Questions regarding NH Health Care Month can be directed to:
Roxie Severance
Health Care Sector Advisor
New Hampshire Health Care Association
rseverance@nhhca.org
603-733-6072

Name of Survey Respondent: *
Your answer
Job Title of Survey Respondent: *
Your answer
Name of NH Secondary School/CTE Center Preregistering: *
Your answer
Street Address of Secondary School/CTE Center: *
Your answer
City, State & Zip Code of Secondary School/CTE Center: *
Your answer
Phone Number and Extension at Which to Reach Survey Respondent: *
Your answer
Email Address of Survey Respondent *
Your answer
Our school would like to visit a: *
Required
Our school has interest in visiting (list 1-3 sites):
Your answer
Our school can travel: *
We would like to bring _____ students to NH Health Care Month 2018. *
Enter a number from 1-25
Your answer
Should additional space become available to attend NH Health Care Month, please contact us, we would like to bring additional students.
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