HIGH Enrollment Interest Form Updated

Full Name

First NameMiddle NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Program

Term

Date of Birth

Date

Gender

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Ethnicity

Primary Language

Secondary Language

Are you currently legally authorized to work in the United States?

If Yes: Which option best describes your current work authorization?

Are you willing and able to complete the required background check and drug screening as part of HIGH's admissions process?

Are you a High School Graduate or have received a GED?

Please upload high school diploma or GED

How did you hear about us?

Your signature below confirms all information in this application (including any supplemental information) is factually true and honestly presented and that you are the person submitting this application.

Your information will be used by Houston Institute of Global Health to contact you about program details, admissions, enrollment support, and related educational opportunities. We do not sell your information or share it with third parties for marketing purposes. By submitting this form, you agree to be contacted by phone, text, or email.

HIGH Interest Form