Affiliation Survey 2025

Region Representing

Region 1
Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Lassen, Modoc, Nevada, Placer, Plumas, Sacramento, San Joaquin, Shasta, Sierra, Siskiyou, Sutter, Tehama, Trinity, Yolo, Yuba

Region 2
Alameda, Contra Costa, Lake, Marin, Mendocino, Monterey, Napa, San Benito, San Mateo, Santa Clara, Santa Cruz, Sonoma

Region 3
Inyo, Kings, Madera, Mariposa, Merced, Mono, Fresno, Kern, Stanislaus, Tulare, Tuolumne

Region 4
Los Angeles, Orange, San Luis Obispo, Santa Barbara, Ventura

Region 5
Imperial, Riverside, San Bernardino, San Diego

Choose your region

Chapter Education Level

Type of funding Chapter/Site/District receives to support your Cal-HOSA chapter

School FundraisingIndustry Partner SponsorshipsCommunity Partner SponsorshipsLocal/Regional GrantsCommunity Partner DonationsIndustry Partner DonationsCTE Foundation FundsLCFFPerkinsCTEIGCalifornia Partnership Academy (CPA)K-12 SWP GrantOther

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Chapter Number

District,
Postsecondary/Collegiate,
or Private School Information

Name of District, Post Secondary/Collegiate, or Private School Email Address Phone

Site Lead
Administrator
Information

Site Lead Administrator First, Last Name Site Lead Administrator Email Site Lead Administrator Phone

CTE Coordinator
Information

CTE Coordinator First, Last Name CTE Coordinator Email CTE Coordinator Phone

Designated School
that the chapter will reside in

Designated School Name School Mailing Address School Phone

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Chapter Advisor Information

Site Chapter Advisor(s)/Instructor(s) Information

Site Lead Advisor First, Last Name (as shown on teaching credential) Site Lead Advisor Email Site Lead Advisor Phone Site Lead Advisor Teaching Credential Name (HSMT/PS)

HSMT Pathway and PS Pathway

List CTE HSMT and/or PS course or courses and Cal-PADS code associated with course that is taught by LEAD advisor.‎

Cal-PADS System Documentation

Select HSMT Pathways or PS Pathway - Emergency Services

Pathway Levels

Introductory

Concentrator

Capstone

Add Pathway/Courses

HSMT Pathway (Add'l Pathway/Courses)

List CTE HSMT and/or PS course or courses and Cal-PADS code associated with course that is taught by LEAD advisor.‎

Select HSMT Pathways

Pathway Levels (Add'l Pathway/Courses)

Introductory

Concentrator

Capstone

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Co-Advisor Information (optional)

Do you have a co-advisor?

Co-Advisor Information

Co-Advisor First, Last Name Email Phone Co-Advisor Teaching Credential Name (HSMT/PS) (optional) + Add Co-Advisor Information

HSMT Pathway or PS Pathway - Emergency Services

List CTE HSMT and/or PS course or courses and Cal-PADS code associated with course that is taught by CO-ADVISOR.‎‎

Select HSMT Pathways or PS Pathway - Emergency Services

Pathway Levels

Introductory

Concentrator

Capstone

+ Add Pathway/Courses

HSMT Pathway (Add'l Pathway/Courses)

List CTE HSMT and/or PS course or courses and Cal-PADS code associated with course that is taught by LEAD advisor.‎

Select HSMT Pathways

Pathway Levels (Add'l Pathway/Courses)

Introductory

Concentrator

Capstone

Add'l Co-Advisor Information

Co-Advisor First, Last Name Email Phone Co-Advisor Teaching Credential Name (HSMT/PS) (optional)

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Please indicate which of the following activities/instruction/services were (or are being) completed to support students' learning.
(Check all that apply) Intra-curricular instruction in pathway coursesGuest Speaker(s)Supporting Clubs: NAMIWork-based learningInternship(s)Counseling ServicesSafe SpaceField TripsApprenticeship(s)HSMT related projectsAssessmentsStudent Training(s)Community Engagement: Rally/Walks/Info TablesCertificationsProfessional Development for Advisors/TeachersOther

What other activities/instruction/services were (or are being) completed to support students' learning?

Certification 1 I certify that to the best of my knowledge and belief that all information in this form is correct. I also understand that failure to report completely and accurately may result in termination of the Cal-HOSA chapter.
Certification 2 I certify that the Cal-HOSA advisor (and co-advisor if applicable) is a CTE HSMT credentialed instructor (secondary chapters) and they teach in CTE HSMT pathway or sequence of courses.
Certification 3 I certify that the school site and the district support the above listed Cal-HOSA chapter and that all Cal-HOSA chapter balances will be paid in a timely manner.
Certification 4 I certify that the Cal-HOSA chapter has in place or will have the appropriate Cal-HOSA Chapter Bylaws for the current school year. These bylaws are modeled after the recommended HOSA bylaws or are designated by the district.

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Affiliation Survey 2025

Region Representing

Choose your region

Chapter Education Level

Type of funding Chapter/Site/District receives to support your Cal-HOSA chapter

Chapter Number

District,Postsecondary/Collegiate,or Private School Information

Site Lead Administrator Information

CTE CoordinatorInformation

Designated Schoolthat the chapter will reside in

Chapter Advisor Information

Site Chapter Advisor(s)/Instructor(s) Information

HSMT Pathway and PS Pathway

HSMT Pathway (Add'l Pathway/Courses)

Co-Advisor Information (optional)

Co-Advisor Information

HSMT Pathway or PS Pathway - Emergency Services

HSMT Pathway (Add'l Pathway/Courses)

Add'l Co-Advisor Information

GDPR

District,
Postsecondary/Collegiate,
or Private School Information

Site Lead
Administrator
Information

CTE Coordinator
Information

Designated School
that the chapter will reside in