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* 1. Please enter your full name

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* 2. Please enter your phone number

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* 3. Home Address (optional)

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* 5. Where are you going to high school (senior/junior)?

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* 6. If you selected "other" above, please the list high school name.

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* 7. Are you interested in pursuing a career in nursing?

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* 8. Can you confirm your attendance at the event? The event will be held on April 10th from 6pm-8pm at Deaconess Gateway Hospital on the 3rd floor in the Gateway Pavilion room.
(Please RSVP to let us know if you’ll be able to join us.)

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* 9. If you RSVP "yes" to this event, please list how many students and parents/guardians will be in attendance. Example: Students: 1, Parents: 2

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* 10. Would you like to take a tour of the nursing units at the Gateway campus?

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