Tomorrow’s Healthcare Experts PARENT/GUARDIAN AGREEMENT Mission: The mission of this program is to close the achievement gap disparities in the health care industry by promoting, encouraging, and educating students on the many health care opportunities and programs, while gaining valuable hands-on experience and knowledge of leading health care careers. Tomorrow’s Healthcare Experts is a program developed by University Hospital to identify, cultivate and motivate future diverse health care leaders. This informative and thought-provoking program introduces participants to health care professions, exposes them to its challenges and opportunities. This program requires full participation in the health care program as outlined in the application. Anyone who has a genuine interest in a career in health care and wants to broaden their knowledge is encouraged to apply. This program requires full participation in the healthcare program as outlined in the application. By completing this form, you are ensuring that your student should be free to participate in each session and agree that if some circumstance occurs which prevents him/her from attending; you will notify the program coordinator. Applications, teacher references and this form are being submitted to University of Missouri Health Care Human Resources no later than September 20, 2013. Interviews will be conducted the between September 23rd through the 27thTH. Each applicant will be notified by phone either way by October 4, 2013. Parent or Guardian Information Students Name: Parent or Guardian's Full Name: Address: City: State: Zip Code: Primary Phone Number: Cell Phone Number: Signature I’ve read the information on the program and I fully support my student’s commitment to Tomorrow’s Healthcare Experts. If selected, I will assist him/her with successful completion of the program X_______________________________________ Parent/Guardian Signature ________________ Date