AHEC Scholars Work Experience for Experiential Hours

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In an effort to make the Missouri AHEC Scholars Program more appealing to and more
manageable for students, it was decided that Missouri AHEC Scholars working clinical jobs will be allowed to count work hours towards the required number of experiential/clinical hours of the Missouri AHEC Scholars Program, provided the job meets the requirements listed below.

Note: HRSA requires that all community-based, experiential, or clinical training be conducted in rural or underserved settings and include a minimum of 40 hours of participation in team-based training.

Scholar first and last name *

Scholar email address *

Name of work site *

Address of work site (please include zip code) *

What type of setting was this? *

Hospital based

Clinic

Other:

Start Date *

YYYY

End Date *

YYYY

Total Hours *

Brief description of responsibilities (Details are good!) *

Requirement #1 - which of the following applies to the site: (check all that apply) *

Accredited as patient centered medical/health home (PCMH)

Clinic that has integrated primary care with mental health and/or oral health services

Clinic that provides team-based care using an interprofessional practice model

Generically, FQHC or certified Rural Health Clinic (RHC)

Rural primary care site serving disadvantaged/vulnerable populations

not sure

Required

Requirement #2 - Please identify the types of professions you interacted with in a team-based care setting (co-workers or students from at least one other profession or engagement with an interdisciplinary team of providers). Check all that apply. *

Physicians, Physician Assistant providers

Physicians, Physician Assistant students

Therapists (PT, OT, Speech, Respiratory)

Therapy Students (PT, OT, Speech, Respiratory)

Social work, counselors, psychiatrists, psychologists

Social work, counselors, psychiatry or psychology students (for example)

Dentists, dental hygienists, dental assistants

Dentists, dental hygienist, dental assistant students

RN, MSN, DNP, Nurse Practitioners, Nurse midwives

Nursing students

Pharmacists

Pharmacy students

Other providers

Other students

Required

If you selected "Other" providers or students, please explain:

Requirement #3: Did you complete the reflection on canvas? *

Submit

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