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PA AHEC SEARCH Academy
Please fill out the application. Once accepted, you will be offered the chance to sign up for each event 3 weeks before it occurs.
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* Indicates required question
Full Name
*
Your answer
Gender
*
Female
Male
Transgender Female/MTF
Transgender Male/FTM
Genderqueer (Neither exclusively male nor female)
Other
Choose not to disclose
Race
*
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
White or Caucasian
Prefer not to say
Required
Ethnicity
*
Hispanic/Latinx
Non-Hispanic/Latinx
Prefer not to say
High School
*
Your answer
Academic year
*
Freshman
Sophomore
Junior
Senior
In which county do you live?
*
Choose
Berks
Carbon
Lehigh
Northampton
Schuylkill
Other
Email address- please use an email address you regularly check as we will be sending you information about the sessions you signed up for.
*
Your answer
Cell phone number- we will text you to sign up for each session
*
Your answer
Do you consent to receive text messages from Pennsylvania AHEC?
*
I agree to receive texts
I do not wish to receive texts
Full mailing address including zip code (we will only send you learning materials)
*
Your answer
Parental/guardian permission is required- please provide your parent or guardian's first and last name
*
Your answer
Parent/guardian email (preferred) or phone number
*
Your answer
Why are you interested in applying for the PA AHEC SEARCH Academy?
*
Your answer
How did you learn about the PA AHEC SEARCH Academy?
*
Teacher or guidance counselor
Parent
Friend
Other:
Are you interested in learning more about a discounted SAT/ACT self-study course from The Princeton Review and PA AHEC?
*
Yes
No
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