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Personal Information
First Name
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Are you currently in middle school, high school or college?
Are you currently in middle school, high school or college?
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Contact Information
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Can your admissions counselor text you?
Can your admissions counselor text you?
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Parent/ Guardian Contact Information
First Name
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Email Address (This email will be used to collect waivers, permission forms and also to send program information and updates.)
Additional Information
Pathway Program Attended or Will Attend:
HPREP - Philadelphia High School
College Mentoring Program - Philadelphia
PMSEP - Philadelphia Middle School
Future Healthcare Scholars - Suwanee
HCC (Health Career Collaborative) - Moultrie
SPARK - Moultrie
SPARK - Suwanee
SPARK - Philadelphia
Thank you for your interest in PCOM Georgia's Future Healthcare Scholars program, created for freshmen and sophomores who have an interest in healthcare professions. The program provides resources and opportunities to help students succeed in high school and be college and/or career-ready upon graduation.
Participants will learn more about PCOM Georgia and our programs in osteopathic medicine, pharmacy, physical therapy, physician assistant studies and biomedical sciences. This program is fully virtual.
High School Name
What is your current grade level?
Middle School Name
Size of t shirt
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XXXL
Brief Essay Question:
In 200 words or less, please complete ONE of the following prompts:
1. Briefly explain why your participation in the Health Professions Exposure Program will develop your interest in pursuing a career in the STEM (Science, Technology, Engineering and Math) Fields.
OR
2. If you could be any organ in the body, what would you be and why?
Please provide a current grade point average.
Please list any school-related, non-school-related, community service or extracurricular activities, such as clubs, organizations and/or sports in which you are involved. Please note if you hold any leadership positions in these organizations.
Please list any honors or awards that you have received during your elementary, middle and high school years. These can include school, community service or extracurricular activities.
Why are you interested in PCOM Georgia's Future Healthcare Scholars program? (We encourage you to provide 250-500 word response).
I plan to graduate from high school.
I plan to graduate from high school.
Yes
No
What is your favorite subject in school?
I plan to go to college.
I plan to go to college.
Yes
No
I have a plan for how I will reach my career goals.
I have a plan for how I will reach my career goals.
Yes
No
I understand how healthcare workers take care of patients.
I understand how healthcare workers take care of patients.
Yes
No
Are you considering a career in healthcare?
Are you considering a career in healthcare?
Yes
No
Maybe
I have a mentor who helps me think about my future.
I have a mentor who helps me think about my future.
Yes
No
I have a mentor who cares about me.
I have a mentor who cares about me.
Yes
No
What college do you currently attend?
Please indicate any food allergies or dietary restrictions below:
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