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1. First and Last Name

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2. Phone Number

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3. Email Address

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4. What High School do you attend?

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5. What grade are you entering this fall (2026)?

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6. Please list any extra curriculars, sports, clubs, or volunteering events you have been a part of.

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7. Please list any relevant courses you have taken related to healthcare.

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8. If hired, when would you be able to start?

Date

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9. We currently have two apprenticeship opportunities; one at the clinic in Appleton and one at the Hospital in Neenah. Do you have a location preference?

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10. Please upload a recent copy of your resume.

Thank you for applying. We will reach out by phone and/or e-mail with next steps if you are selected to proceed in the selection process.

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