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1. 2024 Application

Applications are due April 24th, late applications will not be accepted.
Interviews will be the week of May 6th. 
Everyone will be notified the week of May 15th of their status.
MASH program runs July 8-19th. 

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* 1. Student Name

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* 3. Student Phone

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* 4. Student Address

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* 5. Parent's name

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* 7. Parent's phone

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* 8. Emergency Contact (if different than parent):

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* 9. Please select the name of the school you are currently attending:

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* 10. Please select the name of the hospital you would prefer to attend all 80 hours of the MASH Program:

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* 11. Best efforts are made to accommodate your hospital choice, but space is limited. Would you be willing to attend the program at the other hospital? 

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* 12. Shirt/Blouse Size:

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* 13. Pant Size:

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* 14. List any activities, with dates of attendance (school, community, church) that may interfere with the program. 

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 33% of survey complete.

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