Tell Us Why You Are Interested in Learning About Healthcare Careers
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Sanford Scrubs Club Application
Contact Information
Name
Street Address
City ST ZIP Code
Cell Phone
Home Phone
School and Grade
E-Mail Address
Parent/Guardian
Parent/Guardian Phone in case of emergency
Tell us why you are interested in learning about healthcare careers: Sanford Scrubs Club Application
Please list school activities, work times, and the number of hours per week you are involved. Activity Hours Activity Hours Activity Hours
Your Commitment
Check one: School year ___ Summer ____
The school year program will be held on the 3rd or 4th Thursday, September through April, from 6:30pm to 8:00pm.
Your commitment to the program upon acceptance is essential. One un-excused absence or 2 excused absences will be allowed for the school year program.
Summer program consists of 3 consecutive days in June (TBD) from 1:00pm to 3:00pm. Attendance to each day is essential.
I commit to the program’s attendance policy.
Student’s Signature Date
As parent/guardian of this applicant, I support his/her participation in and commitment to the Sanford Scrub’s Club experience.
Parent’s /Guardian’s Signature Date
Important
School Year Program Application Deadline: September 10th Summer Program Application Deadline: May 10th
All applicants will be notified in writing of the selection committee’s decision
Send completed application to: Sanford USD Medical Center 1305 W 18th St PO Box 5039, Sioux Falls, SD 57117-5039 Attention: Kelly Tollefson /Workforce Development
Fax: 605-333-6304 or email: [email protected]