AHEC Scholars Application
The AHEC Scholars program will consist of the following:
- Clinical activities
- Didactic activities
- Community-based training
- Rural/Underserved Training

The program is open to all students enrolled in healthcare and pre-healthcare certificate or degree programs, from the undergraduate level up. Students will spend a minimum of 80 hours in classroom instruction and 80 hours in hands- on clinical experience, spread out over a period of two years. The requirements of the AHEC Scholars program come in addition to regular coursework required for the student’s academic program.

To become an AHEC scholar, please fill-out the form below.

* Required
First Name *
Your answer
Last Name *
Your answer
Home Address *
Your answer
Email Address *
Your answer
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Which Area Health Education Center are you (will you) be working?
Program of Study *
Do you intend to practice in a rural/underserved area after graduation? *
Please identify your ethnicity by importance
American Indian or Alaskan Tribe
Asian Indian
Black, African American
Caucasian
Chamorro
Chinese
Cuban
Filipino
Japanese
Korean
Mexican, Mexican American, Chicano
Native Hawaiian
Part Hawaiian
Puerto Rican
Samoan
Spanish/Hispanic/Latino
Vietnamese
Other
Primary - 1
Secondary - 2
Tertiary - 3
American Indian or Alaskan Tribe
Asian Indian
Black, African American
Caucasian
Chamorro
Chinese
Cuban
Filipino
Japanese
Korean
Mexican, Mexican American, Chicano
Native Hawaiian
Part Hawaiian
Puerto Rican
Samoan
Spanish/Hispanic/Latino
Vietnamese
Other
Primary - 1
Secondary - 2
Tertiary - 3
If you answered "Other" as an ethnicity, please specify your ethnicity
Your answer
Would you describe yourself as economically disadvantaged?
Can you answer yes to any of the following criteria?

- You are (or will be) the first generation in your family to attend college
- You have or currently receive scholarship or loan for disadvantaged students
- While growing up, you or your family used federal or state assistance programs (Such as free or reduced school lunch, subsidized housing, food stamps, Medicaid, etc.)

Did you answer yes to any of the economically disadvantaged criteria?
Submit
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