Clinical Recruitment Sign-up Form

* = Required Fields

Name*	*
Email*	*Invalid Email
School*	Please select school... Alcorn State University Belhaven Copiah-Lincoln CC Delta State East Central CC Hinds CC Holmes CC Itawamba CC Jones County Jr. Meridian CC Mississippi College MS Delta CC MS University for Women Northeast MS CC Northwest MS CC Pearl River CC UMMC University of Southern MS William Carey University Other *
If other:
Degree*	Please select degree ADN BSN Other Nursing Degree Other Clinical Degree *
If other:
Graduation Date*	*
Area of Interest*	*
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