WASHINGTON AREA HEALTH EDUCATION CENTER (WA AHEC)
Seattle/Olympia Spokane Bellingham Wenatchee
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This is the application for the two-year interprofessional AHEC Scholars Program offered by the AHEC Program Office at the University of Washington School of Medicine (the "WA AHEC Program Office") or the IDAHO AHEC Program Office (newly formed) and their regional AHEC Centers. Eligible students must be in a health professional program that ends in a certificate or degree, after which students will be qualified to find work in their field or discipline. The core topic areas of this program are: interprofessional training, behavioral health integration, social determinants of health, cultural humility, practice transformation, and current and emerging topics. The program includes an optional field trip and a networking event. All students who complete the program will receive a certificate of completion. This is a nationwide Health Resources and Services Administration ("HRSA") program that will identify AHEC Scholar students as having special training and experience with rural and underserved communities.
WA AHEC Scholars Privacy Notice ("Privacy Notice")
By applying to be an AHEC Scholar, the WA AHEC Program Office will collect personal data through the responses you provide below in this application ("Application Data"). If you do not provide your personal data in this application, WWAMI AHEC Program Office will not be able to evaluate your candidacy.uwahec@uw.edu . University of Washington students may learn more about the Family Educational Rights and Privacy Act ("FERPA") by clicking here . WA AHEC Scholars Privacy Notice ("Privacy Notice")
By applying to be a WA AHEC Scholar, the Eastern Washington AHEC (EWAHEC) Office will collect personal data through the responses you provide below in this application ("Application Data"). If you do not provide your personal data in this application, EWAHEC Office will not be able to evaluate your candidacy. here .
WA AHEC Scholars Privacy Notice ("Privacy Notice")
By applying to be a WA AHEC Scholar, the AHEC of Western Washington (AHECWW) Office will collect personal data through the responses you provide below in this application ("Application Data"). If you do not provide your personal data in this application, AHECWW Office will not be able to evaluate your candidacy.info@AHECWW.org . University of Washington students may learn more about the Family Educational Rights and Privacy Act ("FERPA") by clicking here .
Which regional AHEC cohort are you interested in?
Seattle/Olympia WA Online Spokane Bellingham Moscow Boise Pocatello Olympia Wenatchee
Email address
* must provide value
alternate personal email address-for post program contact
* must provide value
First name
* must provide value
Last name
* must provide value
Street address
* must provide value
State
* must provide value
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip code
* must provide value
Mobile phone
* must provide value
I give permission for the AHEC Program to text my personal phone number using a texting app.
* must provide value
Yes No
Date of birth
* must provide value
Today M-D-Y
Have you attended an event through an Area Health Education Center (AHEC) before?
* must provide value
Yes No
What event(s)?
* must provide value
Do you prefer a residential cohort (classes taught in-person on a participating campus) or an online cohort (online participants are required to attend 2 online ZOOM meetings, will be invited to the field trip, and will be part of a networking/ graduation event).
Residential
Online
Not sure yet
If Residential, where do you plan to attend?
* must provide value
Pocatello, ID: Idaho State University
Moscow, ID: University of Idaho
Spokane, WA: Eastern Washington University
Seattle, WA: UW main campus
If Online, why did you choose this option? (Anyone can choose the online experience only, regardless of program or location.)
* must provide value
Please check the following race or ethnicity in which you identify. The Revisions to OMB Directive 15 defines each racial and ethnic category as follows:
* must provide value
American Indian or Alaska Native. A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.
Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
Black or African American. A person having origins in any of the black racial groups of Africa. Terms such as "Haitian" or "Negro" can be used in addition to "Black or African American."
Hispanic or Latino. A person of Cuban, Mexican, Puerto Rican, Cuban, South or Central American, or other Spanish culture or origin, regardless of race. The term, "Spanish origin," can be used in addition to "Hispanic or Latino."
Native Hawaiian or Other Pacific Islander. A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
White. A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Other
Please check the gender with which you identify
* must provide value
Female Male Transgender Non-binary Other gender
Are you a U.S. Citizen or do you have a green card and permanent resident status?
* must provide value
Yes No
If not a U.S. Citizen or green card holder, are you an international student on a student visa or a DACA student?
* must provide value
Yes No
Do you consider yourself coming from an economically or environmentally disadvantaged background?
* must provide value
No Yes Not sure
Are you the first person in your family to attend college?
* must provide value
Yes No
Does your father, mother, or spouse (or the previous employment, if no longer working or deceased) work in healthcare?
* must provide value
Yes No
The option "
Disadvantaged status: please check as many as apply
* must provide value
Veteran Status
* must provide value
Active Duty Reservist Veteran prior service Veteran retired Not a veteran
Where do you live now?
* must provide value
Large city (population 500,000 or more) Suburb of a large city City of moderate size (population 50,000 to 500,000) Suburb of moderate size city Small city (population 10,000 to 50,000-other than suburb) Town (population 2,500 to 10,000-other than suburb) Small town (population less than 2,500) Rural/unincorporated area Undecided
Are you from a non-rural underserved community*?
* must provide value
Yes No Maybe
Where? What community?
* must provide value
Have you ever worked or volunteered in a rural or underserved area doing general or health-related public service?
* must provide value
Yes No
Where and in what capacity?
* must provide value
How long did you do this work or volunteering?
* must provide value
less than 1 month 1 to 3 months 3 to 6 months 6 months to a year More than a year Have not worked or volunteered in a rural or underserved community
What is your school or university?
* must provide value
What is the name of your program or major?
* must provide value
What discipline are you pursuing in your primary program?
* must provide value
Addiction Counseling Anesthesia Assistant Athletic trainer (MS program Exercise Science) Audiologists Certified Nursing Assistant (less than 2 yrs) Clinical Mental or Behavioral Health Counseling Master's or PsyD Communication Disorder specialist Community Health Worker (less than 2 yrs) Dental Assistants (less than 2 yrs) Dental Hygienists Dentistry EMS professional Health Administration Health education specialist Health information technologists Medical Assistants (less than 2 yrs) Medical Coders (less than 2 yrs) Medicine Naturopathic Medicine Nursing Nutritionist Occupational and Physical Therapy Assistants Paramedics (less than 2 yrs) Pharmacy Pharmacy Technician Physical and Occupational Therapists Physician Assistants Prosthetics and orthotics Psychologist Public Health Radiologists Respiratory Therapists Recreation Therapy (Bellingham area only) Social Work Speech-language pathology
What degree will you be earning?
* must provide value
Associates Degree BS MS MPH MHA MD DO ND Doctorate certificate (Recreation Therapy - Bellingham only) DDS PharmD DNP DPT AuD
What year of your program are you in?
* must provide value
1st year
2nd year
3rd Year
Fourth Year
Fifth Year
(if applicable) Do you plan to participate in the RIDE, TRUST, RUOP, or WRITE programs?
Yes
No
What type of time schedule does your school or university use?
* must provide value
Quarter system
Semester system
Other
When does your school/university begin?
* must provide value
Today M-D-Y
When (what month and year) do you anticipate graduating from your primary program?
* must provide value
MM/YYYY
If you have completed at least one quarter/semester of your health professional program, do you have at least a 2.5 GPA?*
* must provide value
Yes
No
Does not apply to me
Please indicate the setting in which you plan to WORK after the completion of your healthcare education.
* must provide value
Large city (population 500,000 or more) Suburb of a large city City of moderate size (population 50,000 to 500,000) Suburb of moderate size city Small city (population 10,000 to 50,000-other than suburb) Town (population 2,500 to 10,000-other than suburb) Small town (population less than 2,500) Rural/unincorporated area Urban Underserved Undecided Other
Specify other
* must provide value
Yes
No
Need more information
I consent to being contacted by the WWAMI AHEC Scholars program one year following graduation about my practice type and work location.
* must provide value
Yes No
In 250-500 words, please write a brief explanation about why you are interested in being a WWAMI AHEC Scholar.
* must provide value
By submitting this application to the WWAMI AHEC Program Office, you:Confirm that you have read and understood the Privacy Notice that appears above; Agree to complete all surveys while participating in the AHEC Scholars Program; Agree to be contacted one year after graduation and to complete additional surveys at that time; Acknowledge that the WWAMI AHEC Program Office is required to report certain personal data, as described above in the Privacy Notice, to the Health Resources and Services Administration ("HRSA") of the U.S. Department of Health and Human Services; and Agree to the release of your personal data, as described above in the Privacy Notice, to HRSA for HRSA's own AHEC program evaluations.
Signature
* must provide value
Today M-D-Y
This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U77HP03022, for the WWAMI Area Health Education (WWAMI AHEC) Program Office and its five regional Centers in the total amount of $788,500 for the 2022-2023 fiscal year (with a 1:1 total match of $788,500 from non-federally funded governmental sources). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.