Launch North Healthcare Career Exploration at Minnesota North

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.Format: (000) 000-0000.

Emergency Contact

First NameLast Name

Emergency Contact Number

Please enter a valid phone number.Format: (000) 000-0000.

Age Group

First-generation college student?

Race/Ethnicity

How did you hear about Launch North?

Photo/Media Consent

I consent to photos/videos being taken during the event for promotional purposes

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

Launch North Healthcare Career Exploration at Minnesota North - Itasca Campus