American Samoa AHEC Scholars Application

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AHEC Scholars is a program for health professions students interested in supplementing their education by gaining additional knowledge and experience in rural and/or underserved urban settings. This is a longitudinal program with interdisciplinary curricula to implement a defined set of clinical, didactic, and community-based activities. All experiential or clinical training will be conducted in rural and/or underserved urban settings.

Program duration is two years and each year includes the following for a total of 160 hours:

40 hours community-based, experiential, or clinical training in rural and/or underserved area
40 hours didactic education (focused on six Core Topic Areas)
Core Topic Areas
Interprofessional Education
Behavioral Health Integration
Social Determinants of Health
Cultural Competency
Practice Transformation
Current and Emerging Health Issues

Eligibility Criteria:

Students should have a current interest in rural or underserved healthcare and be currently enrolled in a health professions degree or certificate program and be two years from program or degree completion. This includes but is not limited to students in medical, dental, pharmacy, nurse practitioner, nursing, physician assistant, social work, physical therapy, occupational therapy, and public/population health programs.

To become an AHEC Scholar, please fill-out this AHEC Scholar Application

Email *

Option 1

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First Name *

Middle Initial

Last Name *

Goes by (Preferred/Nickname)

Date of Birth *

YYYY

Gender *

Male

Female

Contact Number *

Address *

PO Box Number + Village + County (District)

Current Education Academic Year *

Enrollment Status *

Full-time

Part-time

Program of Study *

Expected Program Completion Date (Month/Year) *

If Graduation Date is different, please list it. (e.g. program completion Aug. 2022, graduation date Dec. 2022)

List degrees and/or certificates previously earned:

(N/A if none)

Employment Status *

Full-time

Part-time

Unemployed

Current Employer (if employed)

Employment Start Date

YYYY

Current Profession (position/title)

Ethnicity *

Hispanic/Latino

Non-Hispanic/Latino

Race *

American Indian or Alaska Native

Asian

Black or African American

Pacific Islander

White or Caucasian

More than one race

Veteran Status *

Individual is not a Veteran

Active Duty Military

Reservist

Veteran (Prior Service)

Veteran (Retired)

Do you intend to practice in any of the following settings after completion of your certificate/degree?
*

Individual intends to become employed or pursue further training in a primary care setting

Individual intends to become employed or pursue further training in a medically underserved community

Individual intends to become employed or pursue further training in a rural setting

None of the Above

Other:

Required

How did you hear of the AHEC Scholars Program and why are you interesting in joining? *

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