Extended Deadline is Friday, April 10th! Health Career Exploration Symposium

Transcription

1 Health Career Explratin Sympsium Explring the Pssibilities in Healthcare An intensive day f explratin and hands-n immersin in health careers Thursday, June 25, :00AM-5:30PM Lcatin: Technical Cllege f the Lwcuntry 921 Ribaut Rd, Beaufrt, SC Lwcuntry 9 th -12 th grade students are encuraged t please apply!!!! Extended Deadline is Friday, April 10th! Please share questins with the prgram cntacts: Lwcuntry Area Health Educatin Center (AHEC) 87 Academy Rad Walterbr, SC ffice fax website Katura Williams, MEd williamsk@lcahec.cm r Tracey Wilsn wilsnt@lcahec.cm LT Chahn Chess, MPH chahn.c.chess.mil@mail.mil Lwcuntry Cunties include: Clletn Drchester Bamberg Orangeburg Barnwell Hamptn Allendale Charlestn Berkeley Calhun Beaufrt Jasper

2 2015 Health Career Explratin Sympsium Prgram Applicatin Eligibility: Applicants are required t: A. Be in gd academic standing. B. Demnstrate a sincere interest in a specified healthcare field. C. Understand that the applicatin prcess fr the Health Career Explratin Sympsium is cmpetitive. Submissin f this applicatin des nt guarantee acceptance int the prgram. D. Understand that a $20 registratin fee is required if accepted t attend the Health Career Explratin Sympsium. E. Infrm parents/guardians f pssible acceptance. F. Prvide transprtatin t and frm the Technical Cllege f the Lwcuntry in Beaufrt, Suth Carlina if accepted. G. Participate in ALL aspects f the prgram fr the duratin f the entire sympsium. Directins: Applicatins must be TYPED OR PRINTED IN BLUE OR BLACK INK. A nn-refundable $5 Applicatin fee must accmpany the applicatin. DEADLINE: ALL applicatins must be SUBMITTED by April 10, Cmpleted applicatins must include: º An OFFICIAL cpy f all high schl transcripts. This dcument must be supplied by the registrar f yur academic institutin. º One recmmendatin letter cmpleted by an adult wh is familiar with yur academic wrk and character. Recmmendatins are NOT accepted frm family members. ALL SECTIONS OF THE APPLICATION MUST BE COMPLETED. INCOMPLETE APPLICATIONS WILL NOT BE REVIEWED. EXTENDED APPLICATION DEADLINE: FRIDAY, APRIL 10, 2015 Submit applicatin, transcript, $5 applicatin fee, and recmmendatin letter t: Lwcuntry AHEC c/ Tracey Wilsn 87 Academy Rad Walterbr, SC 29488

3 2015 Health Career Explratin Sympsium Prgram Applicatin GENERAL INFORMATION: On a scale f 1 t 5 (5 being strngly agree) hw wuld yu rate statements 1 and I am interested in pursuing a health career I am interested in entering a military branch Students selected t attend the 2015 Health Career Explratin Sympsium will receive a t-shirt. Please indicate t-shirt size. XXL XL L M S A. DEMOGRAPHIC INFORMATION: 1. Name Last First Middle 2. Hme Address Street & N.. City State Zip Cunty 3. Is yur hme address the same as yur mailing address? YES NO If n, please prvide yur crrect mailing address belw. Mailing Address P.O. Bx City State Zip 4. Age Date f Birth / / Place f Birth M./ Day / Yr. City/Cunty State 5. Sex: Male Female 6. Hme Telephne: ( ) Cell Phne: ( ) Area Cde Area Cde address: 7. Ethnicity: Race (check as many as apply) American Indian r Alaska Native Asian Black r African American Hispanic r Latin Native Hawaiian r ther Pacific Islander White r Caucasian

4 B. ACADEMIC INFORMATION 1. Schl Name: 2. Schl Mailing Address: City State Zip Cunty 3. Current Classificatin: º High Schl: 9 th 10 th 11 th 12 th 4. List any hnrs/distinctins received fr schlastic achievements: 5. List any extracurricular and/r cmmunity service activities (EXCLUDING jbs held during yur high schl/cllege years). Please INCLUDE any AHEC activities. C. FAMILY: 1. Will yu be the first family member t graduate frm a cllege r university in yur husehld? YES NO D. PERSONAL STATEMENT: Why shuld the selectin cmmittee chse yu as a participant in the 2015 Health Career Explratin Sympsium? (Please include yur unique character traits, academic/career gals, and interested in becming a future healthcare prfessinal.) EXTENDED APPLICATION DEADLINE: APRIL 10, 2015 Submit applicatin, transcript, $5 applicatin fee, and recmmendatin letter t: Lwcuntry AHEC c/ Tracey Wilsn 87 Academy Rad Walterbr, SC Prgram Cntacts: Katura Williams, MEd Tracey Wilsn LT Chahn Chess, MPH williamsk@lcahec.cm wilsnt@lcahec.cm chahn.c.chess.mil@mail.mil (ffice) (ffice) (ffice)

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