Apply Now | Bronx Westchester AHEC

Select the program you would like to apply for:*

Date (MM/DD/YYYY)*

Gender*

Male
Female
Prefer not to say

First Name*

Middle Initial

Last Name*

Street Address*

Apt #

City*

State*

Home Phone #

Cell Phone #*

Date of Birth (MM/DD/YYYY)*

U.S. Citizen/Permanent Resident*

Yes
No

Primary Email Address:*

School Email Address:

Languages spoken other than English:

Ethnicity*

Permanent Address (if different from above)

Education*

School Name:*

School City/State:*

Study Area/Major

Expected Graduation Date (MM/YY)*

Check the top 5 Health Careers that interest you:*

What Health issues are you interested in learning about?*

Do you have any family members who are healthcare professionals? If so, who and what profession?

Have you applied to BWAHEC before. If yes, then when?*

How did you hear about the program?*

If selected for the program, in which county would you prefer to be placed during your internship? (Please choose only one)*

Bronx
Westchester

ESSAY QUESTION:*

Please write a 1,000 word essay (typed and double-spaced) discussing your motivation and interest in health careers; indicate any unique qualities, experiences, and other relevant information that makes you a strong candidate for this program.

Your 1,000 word essay should include the following:

Your career goals
How participation in this program will help you achieve your goals
Why you feel you should be selected

Resume

This is not required for high school students, however it is highly recommended for others.

SHIP requires at least one recommendation from a teacher, adviser, mentor, etc. for admission. You may enter their email address here, and they will receive a form to fill out for your recommendation. They may also upload additional documents if they wish.

HCIP requires at least one recommendation from a teacher, adviser, mentor, etc. for admission. You may enter their email address here, and they will receive a form to fill out for your recommendation. They may also upload additional documents if they wish.

First Recommender Email*

Second Recommender Email

Name

This field is for validation purposes and should be left unchanged.

Program Application