Health Professions Interest Form
Program of Interest
The questions below will help us to provide you with the most relevant information.
If you had to pick one, which would be your top program of interest?
Basic Nurse Assistant (CNA)
Central Sterile Service Tech
Clinical Medical Assistant (CMA)
CNA to CMA Bridge
Dental Assistant
Diagnostic Medical Sonography
Electrocardiogram (ECG) Tech
Emergency Medical Services (EMS)
Fire Science Tech
LPN to ADN
Massage Therapy
Medical Coding
Neurodiagnostic Tech
Occupational Therapy aAssistant
Phlebotomy Training
Practical Nurse (LPN)
Radiography
Respiratory Care
Surgial Tech
Transition to Surgial Tech
Vascular Sonography
Vet Assistant
I am unsure
Are there other programs that interest you besides the one you picked above?
Yes
No
Which ones?
Basic Nurse Assistant (CNA)
Central Sterile Service Tech
Clinical Medical Assistant (CMA)
CNA to CMA Bridge
Dental Assistant
Diagnostic Medical Sonography
Electrocardiogram (ECG) Tech
Emergency Medical Services (EMS)
Fire Science Tech
LPN to ADN
Massage Therapy
Medical Coding
Neurodiagnostic Tech
Occupational Therapy aAssistant
Phlebotomy Training
Practical Nurse (LPN)
Radiography
Respiratory Care
Surgial Tech
Transition to Surgial Tech
Vascular Sonography
Vet Assistant
Not Sure
Do you have any of these certifications or degrees?
CNA
CMA
LPN
Sonography Cert
Bachelor's Degree
Associate's Degree
When are you wanting to get started taking classes?
ASAP
Within six months
Within a year
Within two years
Your Academic Background
Did you take high school chemistry?
Please select...
No
Yes
Yes and I got a C or better in it
We dont need an exact number, but roughly, what is your college or high school GPA?
About You
Have you applied to LLCC already?
Yes
No
First Name
Last Name
Phone Number
Email Address
Date of Birth
Contact Preference
Please select...
Call
Text
Email
Which best applies to you?
Please select...
I'm currently in high school
I graduated high school already
I have my GED
I'm working on my GED
None of the above
What High School did you go to?
HS Graduation Year
Or anticipated graduation year
Do you want us to share any information about Health Profession programs with anyone else? Such as a parent, friend, or other relative?
Yes
No
We can share general information about the programs you're interested in so they are aware of the details in addition to you.
Person's Name
Person's Email Address
Person's Relation to You
Please select...
Friend
Parent/Guardian
Family Member
Contact Information