Apply To Be an AHEC Scholar | Illinois Area Health Education Centers

Please use this form to apply.

ABOUT YOU

Your first name *
Your last name *
Your phone *
Your email *

PERMANENT ADDRESS

Street address *
Street address line 2
City *
State / Province *
Zip / Postal code *
County

CURRENT ADDRESS

Is your current address different?
SELECT *

Current street address *
Current street address line 2
Current city *
Current state / province *
Current zip / postal code *
Current county

EDUCATION

School *
Year in school *
Current major(s) *
GPA *
Career goal *
Anticipated Graduation (mm/yyyy) *
Any previous degree(s)?
How did you hear about this opportunity? *

PICK A REGIONAL CENTER

Select your desired center from the dropdown below the map.
Click map image for detailed interactive map or see county list.

SELECT *