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HEALS 2025-2026 Student Application

Student Information

Each section marked with an asterisk indicates a required field.

Student High School*
Answer Required

Parent/Guardian Information

Parent/Guardian 1 Relationship to Student*
Answer Required

Additonal Parent/Guardian Information

Parent/Guardian 2 Relationship to Student*
Answer Required

Student Essay Questions

Please estimate hours obtained during activities such as camps, observations, jobs, course work, volunteering, clubs, or other extra-curricular activities, or personal experiences related to the healthcare field.
Answer Required

Acknowledgements

Please read all of the agreements below throughly, check the boxes, and sign at the conclusion of the application, acknowledging that you have read and understand the information provided.

Admission Process: By checking the box and signing below, I acknowledge that the information that I am submitting including my application, essay responses, transcripts, and standardized test scores will be used to determine my admission into the HEALS program. I understand that a lottery may be used to determine final acceptance into the HEALS program in accordance with the Virginia State Board of Education requirements.*
Answer Required
Admission Commitment: Please check the box below acknowledging that you understand that if you are accepted into the HEALS program, it is a commitment beginning second semester of your sophomore year and continues until your high school graduation.*
Answer Required

Dual Enrollment Agreement

Please read the information below and acknowledge that you have read, understand, and wish to participate in the HEALS Dual Enrollment Agreement as provided.

 

DE

Student's Dual Enrollment Acknowledgement*
Answer Required

Steps for Success

By initialing below, I acknowledge and agree to abide by the stipulations indicated in this agreement.

SS

Student's Steps for Success Acknowledgement*
Answer Required
Parent/Guardian Consent and Acknowledgement: By selecting the box below, I acknowledge that as a student, my parent/guardian must complete the online parental consent form before my application will be considered for admission.*
Answer Required

Congratulations!

You have successfully completed all the information for your HEALS application. At this time, please review the information provided. Once you have reviewed your application, please sign below and click "Submit" to finalize your application.

Please notify your counselor at your high school that you have applied for the HEALS programs so that they may upload additional documents that are required.

 

*As a reminder: Students are NOT required to submit any letters of reccomendation to be considered for the HEALS program.

Student Signature*
Signature Required

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By pressing “Sign Form,” you are agreeing to signing this form electronically.
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Confirmation Email