Student Clinical Travel Grant Application

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Health Professions Students with ties to the East Indiana AHEC region can use this form to apply for travel grants to help offset the cost of transportation to approved clinical sites where they are completing rotations, internships, or clinicals that are part of their degree program.

The East Indiana AHEC region includes the following Indiana counties: Bartholomew, Dearborn, Decatur, Fayette, Franklin, Henry, Jennings, Jefferson, Ohio, Ripley, Rush, Switzerland, Union, and Wayne Counties.

Students from outside the EI-AHEC who are completing training at a site in the EI-AHEC region may receive one award of up to $250 for a rotation / internship / clinical each academic year as funding allows.

Students from the EI-AHEC region or with specific ties to the region as detailed in checkbox selections below may receive one award of up to $350 for a rotation / internship / clinical each academic year as funding allows.

After you complete this application, the East Indiana AHEC team will review your site and student status to ensure you meet award eligibility requirements and then will contact you via the email address you provide with an award decision.

You are welcome to contact becky.niese@eiahec.org at East Indiana AHEC with questions prior to applying.

The travel grant application process must be started prior to rotation, internship, or clinical or during the time it is underway. We are not able to reimburse retrospectively for clinical training placements that were fully completed prior to a student initiating a clinical travel grant application.

First Name *

Last Name *

Email address *

Degree Program In Which You Are Enrolled *

College / University *

Anticipated graduation year *

Current Residence Address *

Permanent Address In EI-AHEC Region

Include this information only if you are a RESIDENT of the EI-AHEC region but your current residence address above is a temporary one at the college or university you attend outside the region. Reminder - the East Indiana AHEC region includes Bartholomew, Dearborn, Decatur, Fayette, Franklin, Henry, Jennings, Jefferson, Ohio, Ripley, Rush, Switzerland, Union, and Wayne Counties

Select all items that apply to your status as a health professions student. *

Reminder - the East Indiana AHEC region includes Bartholomew, Dearborn, Decatur, Fayette, Franklin, Henry, Jennings, Jefferson, Ohio, Ripley, Rush, Switzerland, Union, and Wayne Counties

My academic program is LOCATED IN one of the 14 EI-AHEC region counties

I currently reside in one of the EI-AHEC region counties

My permanant / family address is in one of the EI-AHEC region counties

I participated in an EI-AHEC health careers program while I was in high school or pre-clinical undergrad

My academic program is NOT located in one of the EI-AHEC counties, but I've been placed at a clinical site that IS in one of the EI-AHEC Counties

I am an AHEC Scholar in the EI-AHEC cohort.

Required

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