Program Application APPLICANT MUST BE A U.S. CITIZEN OR PERMANENT RESIDENT Select the program you would like to apply for:*Summer Health Internship Program (SHIP)Health Careers Internship ProgramCommunity Health ExperienceAHEC ScholarsDate (MM/DD/YYYY)*Gender*MaleFemalePrefer not to sayFirst Name*Middle InitialLast Name*Street Address*Apt #City*State*AlAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYHome 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*African AmericanAsianAmerican Indian/Alaskan NativeNative Hawaiina/Pacific IslanderHispanic/LatinoCaucasianOtherPermanent Address (if different from above)Education*HighschoolCollegeUndergraduateGraduateSchool Name:*School City/State:*Study Area/MajorExpected Graduation Date (MM/YY)*Check the top 5 Health Careers that interest you:* Audiologist/Hearing Specialist Alternative Medicine Cardiovascular Technologist Certified Nurse Assistant Clinical Laboratory Services Chiropractic Dental Hygienist Dental Laboratory Technician Dentist Dermatologist Dietician Epidemiology Emergency Medicine Technician (EMT) Forensic Specialist Geriatric Specialst Genetic Counseling Health Administrator Health Education/Promotion Health/Medical Information Technologist Medical Laboratory Technician Medical Illustrator Medical Health Neurologist Nurse Practitioner Orthopedic Medicine Occupational Therapist Physician Physician Assistant Psychologist Public Health Radiology Registered Nurse Social Worker Speech Pathologist Sports Medicine Other What Health issues are you interested in learning about?* Asthma Cancer Diabetes Drug Abuse/Alcoholism Domestic Violence Environmental Health Health Disparities Heart Disease Hypertension HIV/AIDS LGBTQ+ Mental Health STD's Teen Pregnancy Other 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?*FamilyAdvertisingSchoolWebsiteHealth/Career FairFriendIf selected for the program, in which county would you prefer to be placed during your internship? (Please choose only one)*BronxWestchesterESSAY 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 ResumeThis 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 NameThis field is for validation purposes and should be left unchanged.