Fill out the form below on behalf of your students for consideration for student placement at an Aspirus facility.
You will be asked on the form to attest that your school or organization has an academic affiliation on file with Aspirus, has conducted a background check on the students and have verified immunization records. It is advised that you verify these things prior to starting this application, as Aspirus will not consider an application for a student of these criteria are not met. Please note that submission of this form is not a guarantee of the student's placement at Aspirus.
SCHOOL INFORMATION
* Denotes required field
STUDENT INFORMATION
Step 1 of 3. Next: Placement Preferences