Area Health Education Center Program Office

Area Health Education Center Program Office

AHEC Program Office Community Health Scholars Program
...A Service-Learning Expericence for Students

2009 Student Application

Please complete all information as requested. Incomplete applications will not be considered for selection. All fields are required.


Name:
E-mail:
Phone:
Local address:
City:
State & Zip:
Gender:	MaleFemale
Expected graduation date:
Please list any languages you speak other than English:
Do you have reliable transportation?	YesNo
Selected students MUST be available to work full-time for the length of the project. Between what dates are you available to work full-time? to
Which project are you interested in?	Gadsden County School-Based Clinic Project Migrant Summer School Project
Why are you interested in being selected as a Community Health Scholar?
Describe any presentation experience you have had (i.e. public speaking, teaching and/or mentoring).
Describe your leadership experience.
Describe any experiences you have had working with youth and/or underprivileged or underserved populations.
What specific objectives would you like to achieve as a Community Health Scholar?
Personal Statement: Please briefly explain how the Community Health Scholar Program is related to your educational goals?