Launch North Healthcare Career Exploration

Launch North Healthcare Career Exploration - Lake Superior College

Event: Launch North Healthcare Career Exploration Location: Lake Superior College, Duluth, MN Date: March 28, 2025 from 8:00 AM - 3:30 PM Free event with lunch provided
Date

MonthDayYear
Date
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Emergency Contact*

First NameLast Name
Emergency Contact Number*
Please enter a valid phone number.
Do you need a transportation stipend? (Processed after event attendance. Participant must attend 80% of the program to receive stipend.)*

YesNo
Do you need childcare reimbursement? (Processed within 30 days of event attendance. Participant must attend 80% of the program to receive reimbursement. Documentation required. Limited number of childcare assistance scholarships. Available on a first-come, first served basis).*

YesNo
Age Group*

18-24 (College Age)25-34 (Young Adult)35-44 (Adult)45-59 (Mature Adult)60+ (Older Adult)
First-generation college student?*

YesNo
Race/Ethnicity*

American Indian or Alaska NativeAsianBlack or African AmericanHispanic or LatinoNative Hawaiian or Other Pacific IslanderWhiteOther
How did you hear about Launch North?*

Social MediaWorkforce Development CenterLibrary or Community OrganizationTribal OrganizationARDC/Arrowhead Area Agency on AgingFamily or FriendsOther
Photo/Media Consent

I consent to photos/videos being taken during the event for promotional purposes
I do not consent to photos/videos

Program Participation Agreement

"I understand this is a career exploration event with no guarantee of job placement or admission to programs. I commit to attending the full event if selected. I understand that transportation and childcare stipends are processed after event attendance with required documentation."

Contact Permission

"I consent to follow-up contact from Launch North organizers for program evaluation and information about future opportunities."
Signature

Clear
Should be Empty:

Launch North Healthcare Career Exploration - Lake Superior College