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Health Careers Virtual Job Shadow Program Application 2026

Please complete this application to apply to the Health Careers Virtual Job Shadow program. All activities will be conducted virtually. If you have any questions, please contact Amanda Fisher, Executive Director, at (304) 685-0152 or amanda.fisher@nwvahec.org.
1.School Name:
2.County
3.First Name:
4.Last Name:
5.Street Address
6.City
7.State
8.Zip
9.What year are you expected to graduate from high school?
10.What is your current grade level in school? (i.e. 11th grade, 12th grade)
11.What is your date of birth? MM/DD/YYYY
Birthday
12.What is your mobile phone number?
13.What is your home phone number?
14.What is your email address?
15.Please enter your parent/guardian's name(s). (Please enter first and last names)
16.Please enter one parent/guardian's mobile phone number.
17.Please enter one parent/guardian's email address.
18.Are you considering obtaining a degree from a FOUR year college?
19.If no, which of the following best fits your plans? (Choose one that best fits)
20.If you attend college, will you be the first generation of your family to do so?
21.Please indicate the health careers that interest you most. Choose all that apply.
22.Do you feel that you will be more likely to select a health career after participating in the HEALTH CAREERS VIRTUAL JOB SHADOW program?
23.I intend/plan/would like to enter a health career in primary care (such as family medicine, general internal medicine, general pediatrics)
24.I intend/plan/would like to work with people who are medically underserved or where there is not enough healthcare.
25.I intend/plan/would like to work in rural areas.
26.How do you think the HEALTH CAREERS VIRTUAL JOB SHADOW program will help you with your future career choices?
27.What is your favorite class in school and why?
28.What kind of career would you like to have in 10 years?
29.What experiences have you had that support your interest in the health sciences?
30.If selected to participate in this program, I agree to complete all virtual assignments by the deadline.
31.The following questions are for reporting purposes only and do not impact your selection to participate or not participate in the program. Responses are optional.
Which of the following best describes your race?(Required.)
32.Which of the following best describes your ethnicity?(Required.)
33.Which of the following best describes your gender?(Required.)
Current Progress,
0 of 33 answered