• AHEC Alumni

    AHEC Alumni

    Career Information Survey
  • Date of Birth*
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  • Race/Ethnicity*

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  • Can SC AHEC and the regional AHEC centers contact you with the information that you have provided?*
  • From which AHEC Center(s), did you participate in programs and/or received resources?*

  • Did you attend an undergraduate program (2 year or 4 year school)?*
  • Anticipated Graduation*
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  • Graduation Date*
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  • Did you pursue Graduate School or a Health Professions Program?*
  • Are you currently enrolled?*
  • Anticipated Graduation Date:*
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  • Graduation Date:*
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  • Are you interested in being a:*

  • Experience Reflection

    Please share some insight on your experience in the Health Careers Program and how it prepared you for your future career. Health Careers Programs include but aren't limited to the Health Careers Academy, Summer Careers Academy, Regional Summer Programs, Bench 2 Bedside, Academic Advising, Mentoring Program, and Regional Clinical Certification Programs.  

    For continuity, we will use SC AHEC to address participation across the state system in the regional AHEC centers. 

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  • Would you like to include a professional headshot for use with your testimonial?*
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  • By signing below, I certify that the information included in this form is true and accurate to the best of my knowledge.

    My signature authorizes South Carolina AHEC and the regional AHEC centers (Lowcountry AHEC, Mid-Carolina AHEC, Pee-Dee AHEC, and Upstate AHEC) to release information from this application, as they may deem appropriate. Additionally, I grant South Carolina AHEC and the regional AHEC centers permission to use my personal identifiable information for the purpose of federal, state, or grant related tracking to report programmatic outcomes. I also give my explicit permission for the South Carolina AHEC and the regional AHEC Centers to use my image and statements. Uses include but are not limited to photography, videotape, organizational website, or printed media.

  • Date*
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