• 2026 MEDQUEST ENROLLMENT FORM

  • Image field 2

  • Still Accepting Applications for Both Sessions

  • PLEASE SELECT THE SESSION YOU WOULD LIKE TO ATTEND

  • *

  • Note: Capacity is limited Per Session.

  • Format: (000) 000-0000.
  • Are you a U.S. Citizen?*
  • Date of Birth (mm/dd/yyyy)*
     - -
  • Race (check all that apply)
  • Hispanic/Latinx Ethnicity
  • VSAC Student? (GEAR UP/TALENT SEARCH/TRIO)*
  • Anticipated Graduation Year (yyyy)*
     - -
  • I plan to attend college:
  • If so, I am in the first generation of my family to attend college:
  • Has a family member previously attended MedQuest?
  • Format: (000) 000-0000.
  • Financial Assistance Requested:

  • Revised 2/15/26

  • 2026 MEDQUEST ENROLLMENT FORM

  • Supplemental Questions—To be answered by the student

  • Rows

  • COST

  • The cost of the program is $349 per student and includes program materials, scrubs, and meals. SVTAHEC aceepts cash, check, or PayPal. Payment must be made in full by June 15.

  • Immunization Requirements

  • Students and families will be notified of all immunization requirements upon acceptance into the program. If you anticipate needing an exemption waiver for religious or other reasons, please let us know immediately.

  • SIGNATURES

  • I would like to enroll in the MedQuest program and understand that I am expected to participate in all program activities.
  •  - -

  • TO BE COMPLETED BY PARENT/LEGAL GUARDIAN

  •  - -

  • Revised 2/15/26

  • 2026 MEDQUEST ENROLLMENT FORM

  •  - -

  • Revised 2/15/26

  • Should be Empty: