New AzHOSA Chapter Request
Thank you for filling out this form. AzHOSA will send all New Chapter Requests to our National office as they are received. Please note that it may take 1-2 weeks to process and get your new chapter information via email. (Check spam/junk folder as well, as emails come from bulk system.) If you are a brand-new advisor, we also highly recommend you consider attending one of our (FREE) New Advisor Training sessions through the Arizona Department of Education. Please contact Sandra Oligny, AzHOSA State Advisor for more information!
Advisor Name
*
First Name
Last Name
Advisor Email
*
example@example.com
School/Campus
*
School Principal Name
CTE Program
*
Please Select
Bioscience
Sports Medicine
Nursing Services
Medical Assisting
Physical Therapy
Veterinary Assisting
Dental Assisting
Emergency Medical Services
Laboratory Science/Phlebotomy
Mental/Social Health
Other
CTE Director Name
*
CTE Director Email
*
example@example.com
Which best describes your experience as an Advisor?
*
Please Select
New Advisor - New Program/Location
Returning Advisor - New Program/Location
Does your school/campus currently have a HOSA chapter established?
*
Please Select
No, this will be the first HOSA chapter
Yes, but this is a NEW/DIFFERENT CTE PROGRAM
Yes, and in the same CTE program but I will need my own chapter
Submit
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