2025 Summer Enrichment Program Application

Summer Enrichment Program Application
Program Dates By Location:

GREENVILLE: June 3- June 30, 2025

GREENWOOD: June 9 - July 3, 2025
Application Instructions:

The application process this year is 100% online! All application components must be submitted by May 5, 2025, at 11:59 pm.

1. Read the eligibility requirements below and make sure that you fit the requirements.

2. Click the next button below and complete the form. If you are under 18, a consent form will be sent to your parents via email for completion. This form MUST be completed by your parents for your application to be marked as complete. Students 18 and older will receive a link to the consent form in their email.

3. Links to the recommendation form will be sent to your recommenders upon submittal of your application. Make sure to communicate with those you have listed as a contact prior to submitting your application so that they know that the link is coming.

Students will be informed of acceptance into the program by May 5, 2025.
Eligibility
Applicants are required to:
- Be entering the 9th grade or higher by the start of school.
- Be in good academic standing Minimum 2.75 GPA.
- Demonstrate a sincere interest in a specified healthcare field.
- Understand that ALL internship sites will be located within counties included in the specified AHEC's region with an exception to Upstate college students (Upstate AHEC counties included in the region are listed at www.upstateahec.org)
- Understand that the application process for the Upstate AHEC Summer Enrichment Program is competitive. Submission of this application DOES NOT guarantee acceptance into the program or enrichment opportunities.
- Understand that additional forms are required if accepted to attend the Summer Enrichment Program.
- Inform parents/guardians of possible acceptance.
- Provide transportation to the internship placement site and/or drop-off and pick-up locations for the Summer Enrichment Program if accepted.
Material Fee:

There is a $25.00 non-refundable Material Fee for students accepted in the 2025 Summer Enrichment Program.

Payment in the form of: Cash, Cashier’s check, Money Order (Pay to the order of: Upstate AHEC. In the Memo section (HCP).

Payment can be made before the day or on the date of the parent meeting (TBA).

Applicant Name*

First NameMiddle NameLast Name
Date*

MonthDayYear
Age*
Gender*
Race/Ethnicity*
Primary Language*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County*
Neighborhood Type*

UrbanSuburbanRural
Phone Number*

BEST contact for you
Email*
Please include YOUR email address
I will be attending the:*

Greenville LocationGreenwood Location
It is ok for Upstate AHEC and the SC AHEC system to contact me with the information that I have provided. *
Parent/Guardian Name*

First NameLast Name
Relationship*
Parent/Guardian Phone Number*

Area CodePhone Number
Parent/Guardian Email*
example@example.com
Would you like to add contact information for another Parent/Guardian?
Parent/Guardian Name

First NameLast Name
Relationship
Parent/Guardian Phone Number

Area CodePhone Number
Parent/Guardian Email
example@example.com
Number of Immediate Family Members Currently Living in the Household (Including Self)

In 500-750 words, answer the following question:
Why do you want to pursue a career in healthcare and how will participating in the Summer Enrichment Program get you closer to that goal?*

References

Include the contact information of two individuals who are not family members and whom you would like to use as references. hcpstudent@upstateahec.org will email them a letter of recommendation. All references need to be submitted to AHEC by April 30, 2025, at 5:00 p.m.
Reference 1 Name*

First NameLast Name
Reference 1 Relationship*
Reference 1 Email*
example@example.com
Reference 1 Phone Number*

Area CodePhone Number
Reference 2 Name*

First NameLast Name
Reference 2 Relationship*
Reference 2 Email*
example@example.com
Reference 2 Phone Number*

Area CodePhone Number

Academic Information
Academic Grade Level*

9101112Other
Career Interest*
Current Academic Institution*
School Location*
City and State
GPA*
Classification*
What will your classification be the following academic year?
Anticipated Graduation*

MonthDayYear
Guidance Counselor/Advisor Name*

First NameLast Name
Guidance Counselor/Advisor Email*
example@example.com
My signature authorizes South Carolina AHEC andthe regional AHEC centers (Lowcountry AHEC, Mid-Carolina AHEC, Pee-Dee AHEC, and Upstate AHEC) to release information from this application and letters of reference, as they may deem appropriate. Additionally, I grant South Carolina AHEC andthe regional AHEC centers permission to use my/my child's personal identifiable information for the purpose of federal, state, or grant relatedtrackingto report programmatic outcomes. I also give my explicit permission for the South Carolina AHEC and the regional AHEC Centers to use my/my child's image (or likeness) and statements. Uses include but are not limited to: photography, videotape, organizational website, or printed media.
I accept these terms. *
Initials
Date*

MonthDayYear
Date
By signing below, I certify that all information included in this form is true and correct to the best of my knowledge. My signature also indicates the following:
- I understand that this application does not guarantee my acceptance into the Summer Enrichment Program.
- I understand that I am required to complete any preliminary requirements set forth by the shadowing site and expected to complete all of the Summer Enrichment Program requirements set by Upstate AHEC for the Summer Enrichment Program.
- I understand that while stipends may be dispersed for this program, they are NOT guaranteed and I will not receive one unless I meet the requirements set by the Health Careers Program Coordinator.
Applicant's Signature *
Date*

MonthDayYear
Date
Should be Empty:

Summer Enrichment Program Application

In 500-750 words, answer the following question:

References