Waco AHEC Shadowing Program Application

Thank you for your interest in the Shadowing Program with Texas AHEC East - Waco Region! Please complete the application below to be considered for placement. Placement for shadowing is a competitive process and applying does not guarantee a placement. Deadline to Apply: Spring Semester: December 1 Summer Semester: April 1 Fall Semester: July 1 Applications submitted late will not be considered for placement.

Name*

Email*

Phone Number*

Date of Birth*

Gender Identity

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

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How would you describe your race/racial identity?

Is your hometown considered rural?

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Emergency Contact*

Emergency Contact Phone*

Student Type

Undergraduate Student - Independent Shadow

Program of Study

Please include your current program of study/major (ie: Public Health, Biology, Pre-med, etc)

Institution Attending*

Graduation Date*

Have you completed hours with us in the past?*

This includes volunteer hours.

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What semester did you complete hours in the past?

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Which semester are you applying to shadow?*

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Preferred Start Date*

If there is flexibility in your start date, please provide more information in the Additional Information section below.

Preferred End Date*

If there is flexibility in your end date, please provide more information in the Additional Information section below.

Shadowing Area of Interest*

We offer Family Medicine, OB/GYN, and Pediatrics. We cannot guarantee placement with a specific specialty.

Hours Requested*

GPA*

Student Availability*

Please provide an overview of your availability during the week. Shadowing occurs between 8am and 5pm. We cannot accommodate any weekends or evenings.

Are you vaccinated against COVID-19?*

All students are required to fully vaccinated against COVID_19 using either the Moderna, Pfizer, or Johnson & Johnson vaccine.

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Are you interested in learning more about AHEC Scholars?*

The AHEC Scholars program is a national two-year program for students enrolled in various health professions programs. AHEC Scholars is ideal for students interested in obtaining additional training and team-based clinical experiences working in rural areas and/or with underserved populations. Students complete 40 hours of didactic training and 40 hours of experiential training each year.

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Resume and Transcripts*

Please upload a current resume and a copy of your unofficial transcripts.

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Short Answer*

Why are you interested in shadowing with AHEC and Waco Family Medicine? Waco Family Medicine physicians work with patients in underserved and rural areas, why do you feel that you will be a good fit for this patient population? Please answer in 150 words or less.

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