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pjnnwiHedA9cMrJawru5NEHC37NwW3n4x6GiWCqya3cZXCL8tXuCJM6fsaqRAVKYm2ITUbEPbm7dNoT38IVxgBw5dNe96iXqKJnriTXxJCXn

2019 AHEC Application

Program Overview:

The AHEC Primary Care Summer Observership offers first-year IUSM medical students 4-and 8-week preclinical primary care opportunities across the state. These experiences give students a deeper understanding of rural and urban health care, caring for underserved populations, the importance of safety-net organizations and the challenges and rewards of this work and setting.

The AHEC Primary Care Summer Observership pays a stipend of $1500 for a 4-week experience and $3000 for an 8-week experience. Applicants should indicate on the application cover page their preference for either a 4-week or 8-week experience with the understanding that these are only preferences.

Applicants must have their own transportation and housing in the area/s where they apply. Housing is NOT provided. Applicants should indicate on the application cover page those counties that would be within driving distance given his/her housing situation.

This is a competitive application process with selection based on experience, interest in underserved populations, and flexibility in placement location.

Please complete the 2019 AHEC application form below. The application is due on January 28, 2019. Thank you for your interest.

First Name

Last Name

Street, City, State, ZIP

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Contact Phone number

IU E-mail

Date

Y-M-D

Ethnicity

* must provide value

Hispanic or Latino NOT Hispanic or Latino Unknown / Not Reported

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Race

* must provide value

Gender

* must provide value

Female

Male

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Select your IUSM campus

* must provide value

Are you an Indiana Primary Care or National Health Service Corp Scholar?

* must provide value

Yes

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Do you speak Spanish?

* must provide value

Yes

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If YES, rate your fluency.

Beginning

Intermediate

Advance

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Preference 1

Preference 2

Preference 3

Session 1: 8 Weeks ($3000) 6/3-7/26

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Session 2: 4 Weeks ($1500) 6/3-6/28

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Session 3: 4 Weeks ($1500) 7/1-7/26

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Select ALL counties where you have housing, transportation AND would be willing to spend the summer. This information is KEY in selecting participants as the AHEC Summer Observership program cannot provide housing.

*For applicants in and surrounding Vigo County, please apply DIRECTLY to the Summer Hoosier Rural Preceptorship coordinated by the Lugar Center.

* must provide value

Adams

Allen

Blackford

DeKalb

Delaware

Elkhart

Grant

Huntington

Jay

Kosciusko

LaGrange

Madison

Marion

Noble

Randolph

Steuben

Vigo*

Wabash

Wells

Whitley

Cover Page: The questions above serves as the cover page. Did you answer all the questions?

Yes

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ESSAY: In MS-Word, please answer the following essay questions and upload the document.
1. What is your interest in Indiana's medically underserved communities? Please include any experience with underserved populations, experiential/self-directed learning or other relevant experience.
2. Please describe why you'd like to participate in the AHEC Summer Primary Care Observership program, what you bring to the program and how you envision this experience fitting with your long-term professional goals.

* must provide value

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