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Camp Medic Summer Experience Interest Form
Camp Medic (June 15-18, 2026)
Camp Medic Summer Experience will allow students to explore their interests in health careers. This day camp will allow students (rising sophomores, juniors, and seniors) to experience campus while getting a step ahead on their path to working in health care. Camp will take place from Monday, June 15 - Thursday, June 18.
*
Each day drop off will take place from 8:30 AM - 9:00 AM and pick up from 5:00 PM - 5:30 PM
at the Health Professions Building on Ball State campus.
*Parking: Day passes will be provided for students who need a parking pass.
*Space is limited.
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Student Level (hidden)
AC
GR
UG
Student Information
First Name
Preferred First Name
Last Name
Email Address
(personal email, not school email)
Confirm Email Address
(personal email, not school email)
Birthdate
Ball State requests this information for record-keeping purposes only.
Birthdate
Ball State requests this information for record-keeping purposes only.
January
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Mailing Address
Mailing Address
Country
Street
City
Region
Postal Code
Phone Number
Do you give Ball State University permission to contact you via text message? (Hidden - Default Yes)
Yes
No
Please select shirt size
Small
Medium
Large
X-Large
2X-Large
3X-Large
Ethnicity is requested in order to fulfill reporting obligations to various funding grants. Ball State is committed to fostering a diverse campus community in which people from a wide variety of backgrounds, cultures, and perspectives respect and learn from one another. Our equal opportunity and affirmative action policy is available at
www.bsu.edu/legal
.
Are you Hispanic or Latino/a?
Are you Hispanic or Latino/a?
Yes
No
Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member:
Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member:
American Indian or Alaskan Native
Asian
Black or African American
Hawaiian or other Pacific Islander
White
Do you qualify for free/reduced lunch?
Do you qualify for free/reduced lunch?
Yes
No
Will you be a first-generation college student?
(This means that your parent(s) did not complete a 4-year college or university degree)
Will you be a first-generation college student?
(This means that your parent(s) did not complete a 4-year college or university degree)
Yes
No
Are you a 21st century scholar?
(If you are unsure, speak with a parent/guardian or your school counselor about your 21
st
Century Scholar status)
Are you a 21st century scholar?
(If you are unsure, speak with a parent/guardian or your school counselor about your 21
st
Century Scholar status)
Yes
No
Do you require special assistance?
Do you require special assistance?
Yes
No
Please select specific needs:
Please select specific needs:
Wheelchair assistance
Language interpreter
Sign language interpreter
Other
Other
Which language?
Do you foresee transportation as being an issue or a barrier to attending camp?
Do you foresee transportation as being an issue or a barrier to attending camp?
Yes
No
How did you learn about this opportunity?
How did you learn about this opportunity?
On a Ball State Visit
Ball State's Website
Classmate
Flyer
Exploradoor
Other
Other
I will be parking a vehicle on campus during my workshop visit
I will be parking a vehicle on campus during my workshop visit
Yes
No
Why are you interested in Camp MEDIC? Explain what you hope to get out of your time at camp.
School Information
What grade will you be in during the 2026-2027 school year?
What grade will you be in during the 2026-2027 school year?
Sophomore
Junior
Senior
CEEB Code (hidden)
School Name
School Address
School Address
Country
Street
City
Region
Postal Code
Club Medic Areas of Interest(s) within the Health Field
(Select all that apply by holding down the Ctrl button)
Medical & Advanced Practice
Dental
Kinesiology, Sports & Rehabilitation
Nutrition & Wellness
Diagnostics & Clinical Support
Respiratory & Emergency Care
Pharmacy
Mental & Behavioral Health
Public & Community Health
Healthcare Operations
Other
Medical & Advanced Practice
Doctor / Physician
Physician Assistant (PA)
Nurse (RN)
Nurse Practitioner (NP)
Dental
Dentist
Dental Hygienist
Kinesiology, Sports & Rehabilitation
Physical Therapist (PT)
Occupational Therapist (OT)
Athletic Trainer
Exercise Physiologist
Kinesiologist
Sports Medicine Professional
Strength & Conditioning Coach
Personal Trainer / Fitness Specialist
Nutrition & Wellness
Dietitian / Nutritionist
Nutrition Scientist
Health Coach / Wellness Specialist
Diagnostics & Clinical Support
Radiologic Technologist (X-ray/MRI/CT)
Sonographer (Ultrasound)
Medical Laboratory Scientist
Phlebotomist
Respiratory & Emergency Care
Respiratory Therapist
EMT / Paramedic
Pharmacy
Pharmacist
Pharmacy Technician
Mental & Behavioral Health
Psychologist / Therapist
Psychiatrist
Social Worker / Counselor
Public & Community Health
Public Health Professional
Epidemiologist
Health Educator
Community Health Worker
Healthcare Options
Healthcare Administrator
Medical Assistant
Health Information / Medical Records Specialist
Other
Undecided / Exploring
Other (please specify)
Please specify:
Delete
Emergency Contact Information
_ID_
Parent/Guardian Type
Mother
Father
Step-Mother
Step-Father
Legal Guardian
Parent/Guardian First Name
Parent/Guardian Last Name
Parent/Guardian Email
Confirm Parent/Guardian Email
Parent/Guardian Phone
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