Nebraska AHEC Scholars Program Application Form

*Required Fields

To be eligible for the Nebraska AHEC Scholars Program:

  • Be enrolled or accepted in a health profession training program of at least 24 months in duration by Fall 2019
  • Be committed to improving health and health care, devoted to community service, and interested in becoming leaders in navigating and leading in the changing health care system
  • Have achieved at least a 2.5 GPA during the most recent academic year
  • Have access to reliable Internet service

Nebraska AHEC Scholars Program Requirements:

  • Commit to the two-year program
  • Complete 40 hours of approved online and in-person training each academic year
  • Complete 40 hours of approved community-based experiential training per academic year (Note: Required clinical clerkships and/or rotations for your program of study may apply if completed in a rural and/or urban underserved area)
  • Attend in-person events. Eligible travel expenses will be reimbursed.
  • Maintain a minimum 2.5 GPA in program of study
  • AHEC Scholars may be eligible for a stipend annually

To be considered, applicants must meet all eligibility criteria, agree to all program requirements, and submit a complete application. Applications are due by September 16, 2019 and space is limited.

AHEC Scholars of class of 2021 will begin in October 2019. The Fall Workshop will be held October 12, 2019 and is required for all AHEC Scholars to attend.

Preference will be given to applicants with an interest in practicing health care in a rural or urban underserved area, have previous involvement in an AHEC-sponsored program, be from rural or disadvantaged background, or are first generation college students.

After submitting an application, applicants will be contacted to set up a brief group interview via Zoom. Acceptance into the Nebraska AHEC Scholars Program will occur no later than September 30, 2019.

For additional information or questions, please contact Lydia Sand, Program Coordinator, Nebraska AHEC Program.

Before you begin your application!

In order to complete your application, you will need to provide two essay responses and uploaded in one Word or PDF document. Please answer in a typed essay response the following questions:

  1. Describe why you want to participate in the Nebraska AHEC Scholars Program? What do you intend to learn and gain from this experience?
  2. Why are you interested in providing a health care in Nebraska's rural or underserved communities?

Your response is limited to a single 500-word maximum response per question. Consider completing the essay questions before beginning the Nebraska AHEC Scholars Application as you may not save and return to your work in this application. Additionally, you should be prepared to provide extracurricular activities and academic honors as well as listing an academic and personal references. Reminder, once you start this application you will NOT be able to save it.

Section 1: Contact Information


Permanent Home Address
Current Local Address
*Would you like to receive occasional text messages at this number?

Section 2: Demographic Information:

Demographic information is used for federal reporting. It does not impact selection

*Race (Select All That Apply)


*Do you speak any languages other than English?
*Are you or have your served in the military?

Please Check Yes or No to the following statements:

*Will you be the first generation in your family to attend college?

*Do you currently live in a rural community or did you grow up in a rural community (rural is defined as less than 10,000 people)?

*While growing up, did you or your family ever use federal or state assistance programs (e.g., SNAP (formerly food stamps), Medicaid, Social Security Income, Public Housing Assistance/Section 8, etc.)?

Section 3: Academic Information

Where did you attend High School?
Which college or university in Nebraska will you be enrolled or accepted by Fall 2018?
*What academic program will you be enrolled or accepted in by Fall 2018?

Section 4: Interest Information

*How did you learn about the NE AHEC Scholars Program?

*Have you previously participated in AHEC-sponsored programming (e.g., 8th grade science meet, job shadowing, health career club)?

*After the completion of your degree, do you intend to work in a rural or urban underserved area?

Section 5: Essay Questions

Answer each of the following short essay questions with a 500-word maximum response. Upload your responses in a single Word or PDF document.
  1. Describe why you want to participate in the NE AHEC Scholars Program? What do you intend to learn and gain from this experience?
  2. Why are you interested in providing health care in Nebraska's rural or underserved communities?

Section 6: References

Please include contact information for one academic reference and one personal reference. References will be contacted by the Nebraska AHEC Program Office.

Reference 1: Must be a reference within your enrolled or accepted program of study.
Reference 2:

Section 7: Expectations, Agreement, & Release of the NE AHEC Scholars Program

By submitting this application, you acknowledge the following requirements for enrollment in the NE AHEC Scholars Program:
  • A two-year commitment to program completion
  • Maintain enrollment in at least a 18-24-month health profession degree or certification program and meet all the other designated eligibility criteria
  • Complete 40 hours of didactic education and 40 hours of community-based experiential training each academic year. (Note: Required clinical clerkships and/or rotations for your degree/certification may apply if completed in a rural and/or underserved area)

I understand that by completing this application I am applying to participate in the Nebraska AHEC Scholars Program and agree to the above-stated requirements. I agree to provide employment information one year post-graduation and will provide current contact information to the Nebraska AHEC Program Office whenever a change occurs. I understand that through my participation in the program I will be required to provide information necessary for federal reporting.

I am authorizing the provided academic reference(s) to disclose my acceptance or enrollment in their institution and verify my academic standing. The information to be released under this consent is for a recommendation regarding my acceptance into the Nebraska AHEC Scholars Program.

In accordance with the Family Educational Rights and Privacy Act (FERPA), the undersigned student hereby grants to the Board of Regents of the University of Nebraska, its campuses, its representatives, employees, agents and assigns, the irrevocable and unrestricted right to use, reproduce and publish photo/video of me, including my image and likeness as depicted therein, which are identified below, for editorial, trade, advertising or any other purpose and in any manner and medium, and to alter the same without restriction and to copyright the same. 

I hereby release the University of Nebraska, its components, campuses and its Regents, officers, employees, agents, legal representatives and assigns from any and all claims, actions and liability related to its use of said photographs.

I recognize by signing below, I waive any right to royalties or other compensation arising from or related to the use of the photo and/or video.  My signature below also grants the University of Nebraska the use of my image for seven years from the date on this form.

Date: 01/17/2020

Type the text from the image into the space below.

Form last updated 12/12/18

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