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JCU Health Professions Registration/Interest Form
Thank you for your commitment to shaping the future of healthcare by mentoring and educating JCU’s Health Professions students. Your expertise and guidance are invaluable in nurturing the next generation of healthcare professionals and administrators.
Even if you are unable to engage with our students, we ask that you please respond. Knowing where and how you work in healthcare will be valuable as we build our College of Health and celebrate the successes of our alumni
.
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First Name:
Last Name:
Previous Last Name
(
If different than above
):
Birthdate:
John Carroll Alum:
John Carroll Alum:
Yes
No
Year of JCU graduation (Undergrad) (Please use XXXX):
Year of JCU graduation (Graduate) (Please use XXXX):
Email:
Please provide your address:
Please provide your address:
Country
Street
City
Region
Postal Code
Current title:
Current employer
Employment Status:
Employment Status:
Actively working in a healthcare-related field
Actively working in a non-healthcare related field
Retired from a healthcare-related field
Retired from a non-healthcare-related field
I am currently a student in a healthcare-related area of study
Professional Industry: Please select the option below that most closely aligns with your profession.
Professional Industry: Please select the option below that most closely aligns with your profession.
Healthcare and Medicine
Legal and Law Enforcement
Education
Finance and Accounting
Business and Management
Marketing and Sales
Manufacturing and Trades
Transportation and Logistics
Environmental and Agricultural
Social Services and Counseling
Credentials: Please select the option below that most closely aligns with your credentials.
Healthcare and Medicine
Healthcare and Medicine
DO, MD (Doctor of Medicine)
CNA, LPN, RN, APRN (Certified Nursing Assistant, Licensed Practical, Registered Nurse, Adv Practice Reg. Nurse)
CNP (Certified Nurse Practitioner)
PA-C (Physician Assistant)
CAA (Certified Anesthesiologist Assistant)
PhD (Doctor of Philosophy) - for medical researchers
PharmD (Doctor of Pharmacy)
DDS or DMD (Dentistry)
OD (Optometry)
DPM (Podiatric Medicine)
DPT (Physical Therapist)
OT (Occupational Therapist)
ATC (Athletic Trainer)
EPC or CEP (Exercise Physiologist)
Legal and Law Enforcement:
Legal and Law Enforcement:
JD (Juris Doctor) - Law Degree
LEO (Law Enforcement Officer Certification)
Education:
Education:
NCSC (National Certified School Counselor)
Teaching Certification
Finance and Accounting:
Finance and Accounting:
CPA (Certified Public Accountant)
CFA (Chartered Financial Analyst)
CFP (Certified Financial Planner)
CMA (Certified Management Accountant)
Business and Management:
Business and Management:
MBA (Master of Business Administration)
PMP (Project Management Professional)
HR Certification (e.g., SHRM-CP, PHR)
CFA (Chartered Financial Analyst) - for investment and finance roles
Certified Business Analysis Professional (CBAP)
Certified Manager (CM)
Marketing and Sales:
Marketing and Sales:
Certified Digital Marketing Professional (CDMP)
Certified Sales Leadership Professional (CSLP)
Certified Marketing Executive (CME)
Social Sciences and Counseling:
Social Sciences and Counseling:
LCSW, LISW (Licensed Clinical or Independent Social Worker)
LMFT (Licensed Marriage and Family Therapist)
LPC (Licensed Professional Counselor)
CCLS (Certified Child Life Specialist)
I am interested in supporting students in the following way(s):
I am interested in supporting students in the following way(s):
Teaching (seminars, guest lectures, course development)
Mentorship (attend JCU events, meet with students to take on mentorship roles)
Research opportunities (clinical and/or bench research)
Preceptorship/clinical experiences (shadowing, volunteer, employment)
All Questions may be directed to: CoH@jcu.edu
Submit