Get Georgia Statewide Ahec Support Form - Three Rivers Ahec - Threeriversahec

Filling out the Georgia Statewide AHEC Support Form is an essential step for individuals seeking support from the Three Rivers AHEC. This guide provides clear instructions on completing the online form efficiently and accurately.

Follow the steps to successfully complete your form.

1. To begin, locate the ‘Get Form’ button and click on it to access the support form for Three Rivers AHEC online.
2. Enter your first and last name in the designated fields. If you have a middle name or maiden name, please include those as well.
3. Provide your birthdate, ethnicity, and gender information. Select how you prefer to be addressed by filling in the 'Goes By' field.
4. Input your contact details including your mobile phone, home phone, and personal email address. If you have a school email, please include that as well.
5. Fill out your current mailing address, including street address, city, state, zip code, and county.
6. Provide information regarding your next of kin, including their name, relationship to you, and contact number.
7. Indicate the high school you graduated from, including the state and county.
8. Specify your birth country and the name of the school you currently attend, along with your expected graduation date and contact information for your school.
9. Indicate if you are a National Health Service Corps (NHSC) scholar, if you speak Spanish, and your degree program name.
10. Provide your military status, and answer whether you have been determined to be from a disadvantaged background or have demonstrated financial need.
11. Complete the survey information sections using the scale provided; indicate your intentions regarding working in rural or underserved settings.
12. For rotation information, fill in the start and end dates, number of days, and clinical training hours.
13. Provide preceptor information, including their name, title, specialty, contact details, and site name.
14. Complete the AHEC use section if applicable, including street address and types of support provided.
15. Once you have filled out all required sections, review the information for accuracy. Finally, you can save changes, download, print, or share the completed form as needed.

Start your application process today by filling out the Georgia Statewide AHEC Support Form online.