2021 Health Careers Institute at Dartmouth (HCID)

2021 Application

To assist you in creating a competitive application, please read through the Guidelines here.

Instructions to complete the application:

1) Please be advised this application must be completed in one sitting. You cannot save your work and return to the application. Fields with an asterisk* are required.

2) Please consider working on the following statement prior to beginning your application.

Help us learn about you and your ambitions. Please select one of the writing prompts listed below then write a response in the space provided in the application. NOTE: there is a minimum 250-word requirement and a 500-word limit!

Tell us about a significant experience, challenge, achievement, a risk you have taken, or difficult decision you have faced and its impact on you
Discuss some issue of personal, local, national, or international concern and its importance to you
Tell us about a person who has had a significant influence on you and describe that influence
Describe a fictional character, an historical figure, or a creative work (art, music science, other) that has had an influence on you and explain that influence.

3) Parent/Guardian information must also be completed upon submission.

4) Students must have a completed HCID recommendation form submitted. The form can be downloaded from the Timeline-Application-Fees webpage – it is a form that can be filled in and should be submitted via email or mail directly to HCID by the person preparing it.

If you would like more information or assistance, please contact lillian.emerson@dartmouth.edu, call (603) 646-1225.

First Name

Preferred First Name

Last Name

Mailing Address

Country

Street

City

Region

Postal Code

Phone Number

Email Address

Birthdate

Gender

Male

Female

Are you Hispanic or Latino?

Yes

No

Do not wish to share this information

High School Name

Grade (entering)

10

11

12

School City

School State

Parent/Guardian Information

Please provide contact information for at least one parent/guardian.

Parent/Guardian Name

Parent/Guardian Mailing Address

Country

Street

City

Region

Postal Code

Parent/Guardian Phone Number

Parent/Guardian Email Address

Second Parent/Guardian Information

Second Parent/Guardian Name

Second Parent/Guardian Mailing Address

Country

Street

City

Region

Postal Code

Second Parent/Guardian Phone Number

Second Parent/Guardian Email Address

Which section would you like to attend?

June 28 through July 2, 2021

What Are Your Plans After You Graduate From High School?

Have you attended other health career programs?

Yes

No

If yes, which ones?

Why are you interested in a health career?

If other, please specify

What do you want to take away from the Health Careers Institute at Dartmouth?

Help us learn more about you and your ambitions. Please select one of the writing prompts listed below, then write a response in the space provided.

Tell us about a significant experience, challenge, achievement, a risk you have taken, or difficult decision you have faced and its impact on you.

Discuss some issue of personal, local, national, or international concern and its importance to you.

Tell us about a person who has had a significant influence on you and describe that influence

Describe a fictional character, an historical figure, or a creative work (art, music, science, other) that has had an influence on you and explain that influence.

Please insert your statement, no less than 250 words and up to 500 words, here

Help Create Your Unique ID

First letter of town/city AND state you were born in (Example - you were born in Houston, Texas you would put HT)

Initials of your mother's First Name AND her Maiden Name (Example - your mother's name is Kathy and her maiden name is Cassidy you would put KC)

The last two digits of your social security number (If you do not have a social security number use 00)

Unique ID - Combine the three above letters and numbers (Example - based on the samples given, the unique ID would be HTKC00)

Sets the record as an applicant

Applicant

Education

Research

2021 Health Careers Institute at Dartmouth (HCID)