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Healthcare Pathways Interest Form
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Email:
healthcarepathways@sunyacc.edu
Phone:
518-743-2256 (Queensbury), 518-832-7654 (Saratoga)
Contact Information
First Name
Middle Name
Last Name
Date of Birth
Date of Birth
January
February
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Email Address
Phone Number
Mailing Address
Mailing Address
Country
Street
City
Region
Postal Code
General Information
Are you a current SUNY Adirondack student?
Are you a current SUNY Adirondack student?
Yes
No
Banner ID (if known)
Which health care program? Please specify major/training program.
Which campus do you take the majority of your classes?
Which campus do you take the majority of your classes?
Queensbury
Saratoga
How were you referred to us? Please specify employer/facility/program.
Where would you prefer to take most of your classes?
Where would you prefer to take most of your classes?
Queensbury
Saratoga
Are you currently registered or plan to register for a SUNY ADK nursing workshop?
Are you currently registered or plan to register for a SUNY ADK nursing workshop?
Yes
No
Date
Date
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
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31
2000
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2005
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2008
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2010
2011
2012
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2014
2015
2016
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2020
2021
2022
2023
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2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
What types of support would you be interested in discussing? Check all that apply.
What types of support would you be interested in discussing? Check all that apply.
Workshop or training completion stipend
Exam fees or Career Advancement Opportunities (health care related)
Gas cards or assistance with transportation barriers
Textbook, uniform, or required course materials, vouches
Other personalized support and assistance
Please list any additional comments or questions below:
Submit
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