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HOSA Student Questions

1. First and Last Name

Please note that last minute requests are difficult to accommodate and may not be met. Please submit your request at least two to four weeks before your earliest interview by date.
Thank you!

2. City and State: *This question is required.

3. Email address: *This question is required.

4. Name of School: *This question is required.

5. Grade or Year: *This question is required.

6. Name of Teacher or Advisor: *This question is required.

7. Email address of Teacher or Advisor: *This question is required.

8. Name of HOSA Chapter (if known):

9. What is the earliest date you would be ready to conduct interviews with a family physician or medical student: *This question is required. This question requires a valid date format of MM/DD/YYYY.

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10. What is the latest date you would be ready to conduct interviews with a family physician? *This question is required. This question requires a valid date format of MM/DD/YYYY.

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11. Are you planning to compete in the HOSA competitions?: *This question is required.

12. At what level will you first be competing? (local, state, regional, national): *This question is required.

12. Approximate date of first competition: *This question is required. This question requires a valid date format of MM/DD/YYYY.

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13. Have you identified a family physician that you plan to interview? *This question is required.

14. Please provide the name of family physician that you plan to interview: *This question is required.

14. Have you identified a medical student that you plan to interview? *This question is required.

15. Please provide the name of the medical student you plan to interview: *This question is required.