Pre-Clinical Gap Year Program Interest Form

We’re thrilled that you’re ready to take the next step in your healthcare journey by applying to the Pre-Clinical Gap Year Program. Please complete the form below to submit your application and bring yourself one step closer to gaining hands-on experience with Maine’s leading healthcare providers. We look forward to learning more about you and supporting your growth in the healthcare field!

Fill out the interest form below and a member of our staff will schedule an initial phone call. For questions specific to the program please email [email protected]

Degree
Do you have any current health-related certifications or licenses? (Check all that apply)
What healthcare profession(s) are you interested in? (Check all that apply)
Which of the program's healthcare employer partners most interest you?
Which of Maine's geographic areas most interest you for placement?
What is your gender identity?
What is your ethnic background?