Many students regularly contact High Point Regional expressing their interested in applying for internships/clinical experiences. If you are interested in learning more about our programs, then please complete the form below. We ask that you complete all of the fields below, but do not require you to do so. This is our way of better understanding your needs and interests. If you have any questions, please click here to email them to our staff.

Please note: Your information will not be shared with outside sources or vendors.

Full Name:
(Last) (First) (Middle)
Current Home/Campus Address:
Street: City: State: AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV" NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip:
Home Phone:
Cell Phone:
Email:
Name of College/University:
Academic Program:
Expected Graduation Date:
Have you previously worked or volunteered at High Point Regional Health System?  Yes No
If yes, please provide department: Date Started: Date Ended: