Sentara Health - Your Community Not-For-Profit Health Provider

Which camp location are you applying to? (select one)*

Session 2 (July 14 - 18,2025 | 9:00 a.m. - 2:00pm.)

Sentara Martha Jefferson Hospital Sentara Norfolk General Hospital Sentara Northern Virginia Medical Center Sentara Williamsburg Regional Medical Center

PERSONAL INFORMATION

Student name*

Preferred name*

Birth date*

Student email (personal email, not school-associated email)*

City*

State*

ZIP code*

Scrubs size: *

*Please be advised that camp-issued scrubs come in adult unisex sizes. It is recommended that students select a size that is 1 to 2 sizes smaller than their usual size to ensure a better fit.

SCHOOL INFORMATION

Name of school*

Grade entering this fall: *

Teacher name*

Teacher email*

All applicants are required to have a teacher recommendation. It is the responsibility of each applicant to ensure the teacher recommendation form is submitted by March 28, 2025, for camp consideration.

How would you rate your academic performance? *

Poor Fair Good Very Good Excellent

Race:*

American Indian or Alaskan Native	Asian or Pacific Islander	Black
Hispanic	White	Two or more races
Choose not to answer	Other

Gender: *

Female Male Non-binary Choose not to answerOther

Pronouns:

He/Him/His She/Her/Hers They/Them/Theirs Other

Language(s) Spoken:*

Do you need or want an interpreter for us to communicate with you or your parent/guardian?* Yes No

What or who inspired your interest in science, health, and wellness?*
Please share any specific experiences or events that sparked your passion. (200 words max)

If you could invent a tool or program to improve people's health, what would it be and how would it help?*
(200 words max)

Explain how you stay motivated when learning something new or challenging, especially in science or wellness topics.*
(150 words max)

Accommodations *
Does the applicant have any food restricitions, allergies, significant health history (e.g., heart condition, diabetes, any injury), or health restristricions that the Sentara Health Career Camp staff should be aware of?

Parent/Guardian name(s)*

Parent/Guardian phone Number: *

Parent/Guardian email:*

What is the best way to contact the Parent/Guardian?*

Email Phone Text

Will the student need transportation to and from camp? (Please specify your preferred pick-up/ drop-off location if it differs from the address listed in your application) *

Yes No

Parent/Guardian consent

By typing your name in the below box, you grant permission for your child to participate in Sentara's Health Career Summer Camp. Additionally, you are acknowledging that photos or videos may be taken during the camp for promotional purposes and consent to their use.

Parent/Guardian electronic signature*

Today's date: 4/25/2025

Application