Health IT Learn & Earn Application
Please complete the following questions to the best of your ability.
Name: *
Address (include permanent and school if different) *
Preferred Email Address: *
Phone Number: *
High School Attended: *
College of enrollment: *
If enrolled in two year college, what college do you anticipate attending next fall? Note (all program participants must be enrolled in a four year institution in the fall of the 2019 academic year)
This program only accepts 2nd year students at this time. Please confirm that you are a 2nd year student: *
What is your major or anticipated major? *
Are you the first in your immediate family to attend college? *
Please list your extra-curricular activities (high school and college): *
Please list your awards and achievements (high school and college) *
Please list your Technical Skills (e.g. java, C#, etc.) *
Attach two letters of recommendation required (one must be from a professor of a core class) *
In 300 – 500 words please explain why the Health IT ‘Earn & Learn’ program would be valuable to you *
List of current courses and projected spring semester courses: *
GPA (major, if applicable)
GPA (overall, required) *
Please attach your resume *
Link for GitHUB account if available
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