Waco AHEC Internship Application

Thank you for your interest in Waco AHEC's Internship Program. Please complete this application in full. Please note, you will not be able to save your application, so you will need to submit the entire form.

You can learn more about the position here.

You can learn more about Waco AHEC here.

Personal Information

First Name*

Last Name*

Application Date*

Email Address*

Phone Number*

Phone

Current Address*

Please provide your current student address.

Are you of Hispanic, Latino, or of Spanish origin?

Yes

How would you describe your race/racial identity?

Gender Identity

College or University Specific Information

Institution Attending*

Major/Program of Study*

In what semester are you looking to intern?

Select or enter value

Are you a virtual or in-person student?*

Virtual

In-Person

How many credit hours are you taking?*

Are you considered a full-time student?*

Yes

Graduation Date*

Please list any major commitments outside of your courses.*

This includes jobs, student organizations, athletics, volunteer commitments, academic commitments, or other research commitments.

Position Specific Information

What is your past experience or training in engaging with diverse or underrepresented populations?*

You can learn more about the All of Us Research Program's commitment to diversity here.

Are you Interested in the AHEC Scholars Program?*

The AHEC Scholars Program recruits and trains a diverse group of health professions students, creating an interprofessional team of health professionals committed to serving rural and/or underserved communities and the transformation of health care in Texas. You can learn more about the program here.

Yes, please send more information

Not at this time

I would like to learn more about the program

How did you hear about this internship?*

Please upload a resume or CV*

Please upload a PDF document.

Drag and drop files here or

Certification

NOTE: PLEASE CAREFULLY READ THE STATEMENTS BELOW. AFTER YOU HAVE READ THE STATEMENTS, PLEASE SIGN AND DATE IN THE SPACE PROVIDED BELOW.

“I certify that the facts contained in this application and in any resume or other material provided to Texas AHEC East - Waco Region (Waco AHEC) and in any oral statements by me are true and complete to the best of my knowledge. I understand that, if employed, omissions, incomplete statements, or false statements on this application or other materials supplied to Waco AHEC or in oral statements by me in the hiring process shall be grounds for dismissal.

I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN. THIS INVESTIGATION MAY CHECK CRIMINAL, CREDIT AND MOTOR VEHICLE RECORDS.

I agree to fully cooperate in this investigation, including personally requesting any information as necessary. Further, I authorize the employers and references listed above to give Waco AHEC any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to Waco AHEC.”

I UNDERSTAND AND AGREE THAT, IF HIRED:

1. My employment is for no definite period but may be terminated by Waco AHEC at any time without any prior notice and without cause.

2. No officer or employee of Waco AHEC can guarantee me any specific salary or benefit or employment for any period of time, except by written agreement between me and Waco AHEC signed by the AHEC Executive Director or the Treasurer of Waco Family Medicine.

3. I will comply with all rules and regulations of Waco AHEC including the Drug-free Workplace, Confidentiality and Tobacco-Free Workforce Policies. Failure to comply will result in employment and or financial penalties as deemed by Waco AHEC. I understand that Waco AHEC rules, regulations and policies are not a contract and may be changed or waived by Waco AHEC at any time.

Do you agree?*

I agree

I do not agree

Please type your name in full to digitally sign the electronic application.

Send me a copy of my responses

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