HEAG Foundation

2017 Summer Medical Internship Application
For Guilford County High School Juniors and Seniors

Applicant Name:

Applicant Age:

Parent/Guardian Name:


Street Address:



Zip Code:

Telephone Number:

High School:

E-mail Address:

Facebook Page/Name:

How many days were you absent from school during the 2016-17 academic year?

What are your plans after high school?

What area of the medical field are you interested? Why?