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2023-2024 East Indiana AHEC Scholars Hours Submission
Please submit this form for any and all hours that you have completed. Approval of hours will appear in Canvas under hours in the gradebook.
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* Indicates required question
Name
*
Your answer
Select one
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Year 1 AHEC Scholar
Year 2 AHEC Scholar
Check the type of hours you are submitting
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Regionally Planned experience
Non-Canvas Didactic hours (conferences, webinars, CEU's, podcast, etc)
Independent Hours (clinical/rotation, healthcare work hours, or volunteer healthcare hours)
Other:
Required
Name of experience
*
Your answer
Location of experience
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Your answer
Start date of experience
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MM
/
DD
/
YYYY
End date of experience
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MM
/
DD
/
YYYY
Total hours spent at the experience
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Your answer
Drive time to the experience (one way)
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Your answer
Which core topic area(s) were discussed or could be applied to this experience? Check all that apply
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Behavioral Health Integration
Cultural Competency
Interprofessional Education/Practice
Practice Transformation
Social Determinants of Health
HRSA Defined Current and Emerging Health Issues: COVID-19, Opioid Epidemic, Zika Virus
Connecting Communities and Supporting Health Professionals
Virtual Learning and Telehealth
Required
Description of the experience
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Your answer
Summarize duties performed, lessons learned, goals met, activities, etc. How will this improve your readiness to practice as a health professional? Be sure to describe how this experience addressed the core topic(s) identified above.
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Your answer
Would you recommend this experience to future AHEC Scholars? Why or why not?
*
Your answer
Additional Comments:
Your answer
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