Information
Name of Person Completing Form:
Phone Number of School: (Use Public Number or Main Office Number)
* This is to be the official phone number of the school you are filling out this form for. This will be your school's identification.
Please Indicate Whether You Are Filling Out A New Form For Your School or Updating An Existing One:
I am creating a new form for our school.
I am updating information for our school(I had previously filled out this form for our school).
School Information
Type of School:
Please select...
High School
Career and Technical School
College or University
Name of School:
Street Address 1
City
State
Please select...
IN
KY
MI
OH
Postal/Zip Code
School Nurse Aide Program
Do You Currently Have a Nurse Aide Program?:
Yes
No
Are You Interested in a Nurse Aide Program?:
Yes
No
What Are The Features of Your Current Program?(Click all that Apply)
We don't have a teacher, classroom/lab and health provider
We have a teacher, but no classroom/lab and health partner
We have a teacher and classroom/lab, but no health partner
School Culinary Program
Do You Currently Have a Culinary Program?:
Yes
No
Are You Interested in a Culinary Program?:
Yes
No
Additional Experiences
Freshman/Sophomore Experiences
Check Yes or No for each of these programs to express interest in them.
Yes
No
Take a tour of one of our Trilogy campuses and meet some of the people working there.
Providing a guest speaker for a special occasion, event or class.
Speak with a resident to learn about their lives.
Have students shadow Trilogy employees as they learn more about the healthcare field.
Learn what the residents have on their bucket list and make them come to life
Participate in some of Trilogy's multiple different charity drives.
Help residents with campus activities.
Have students follow in the everyday life of one of our residents and learn what care giving is all about.
Spend time gardening with our residents.
Junior/Senior Experiences
Check Yes or No for each of these programs to express interest in them.
Yes
No
Trilogy will provide students with a paid or un-paid work opportunity during Junior and Senior year.
Conduct mock interviews with students and review student resumes.
Take part in Trilogy's apprenticeship pathway.
Students will be able to work with Trilogy during the summer.
Participate in some of Trilogy's multiple different charity drives.
Help residents with campus activities.
Attend a career fair at your school and present all the opportunities Trilogy has to offer.
Spend time gardening with the residents of our campuses.
Individual to Contact
Please indicate the primary individual to contact from your school or institution:
Name of Contact Person:
Email Address of Contact Person:
Phone Number of Contact Person:
If you have any questions, comments, or concerns please feel free to put them in this box and we will help you as soon as we can!
Contact Information