Health Career Exploration
Symposium
“Exploring the Possibilities in Healthcare”
An intensive day of exploration and hands-on
immersion in health careers
Thursday, June 25, 2015
8:00AM-5:30PM
Location: Technical College of the Lowcountry
921 Ribaut Rd, Beaufort, SC 29902
Lowcountry 9th-12th grade students are
encouraged to please apply!!!!
Extended Deadline is Friday,
April 10th!
Please share questions with the program contacts:
Lowcountry Area Health
Education Center
(AHEC)
87 Academy Road
Walterboro, SC 29488
843-782-5052 office
843-782-5053 fax
www.lcahec.com website
Katura Williams, MEd
[email protected]
843.782.5052
or
Tracey Wilson
[email protected]
843.782.5052
LT Chahn Chess, MPH
[email protected]
843.228.3958
Lowcountry Counties include: Colleton ♦ Dorchester ♦ Bamberg ♦ Orangeburg ♦ Barnwell ♦ Hampton ♦ Allendale ♦ Charleston ♦ Berkeley ♦ Calhoun ♦ Beaufort ♦ Jasper
2015 Health Career Exploration Symposium
Program Application
Eligibility:
Applicants are required to:
A. Be in good academic standing.
B. Demonstrate a sincere interest in a specified healthcare field.
C. Understand that the application process for the Health Career Exploration Symposium is competitive. Submission
of this application does not guarantee acceptance into the program.
D. Understand that a $20 registration fee is required if accepted to attend the Health Career Exploration
Symposium.
E. Inform parents/guardians of possible acceptance.
F. Provide transportation to and from the Technical College of the Lowcountry in Beaufort, South Carolina if
accepted.
G. Participate in ALL aspects of the program for the duration of the entire symposium.
Directions:
 Applications must be TYPED OR PRINTED IN BLUE OR BLACK INK.
 A non-refundable $5 Application fee must accompany the application.
 DEADLINE: ALL applications must be SUBMITTED by April 10, 2015.
 Completed applications must include:
º An OFFICIAL copy of all high school transcripts. This document must be supplied by the registrar of
your academic institution.
º One recommendation letter completed by an adult who is familiar with your academic work and character.
Recommendations are NOT accepted from family members.
 ALL SECTIONS OF THE APPLICATION MUST BE COMPLETED. INCOMPLETE APPLICATIONS WILL NOT
BE REVIEWED.
EXTENDED APPLICATION DEADLINE: FRIDAY, APRIL 10, 2015
Submit application, transcript, $5 application fee, and recommendation letter to:
Lowcountry AHEC
c/o Tracey Wilson
87 Academy Road
Walterboro, SC 29488
2015 Health Career Exploration Symposium
Program Application
GENERAL INFORMATION:
On a scale of 1 to 5 (5 being strongly agree) how would you rate statements 1 and 2.
1. I am interested in pursuing a health career.
□ 1
□ 2
□ 3
□ 4
□ 5
2. I am interested in entering a military branch.
□ 1
□ 2
□ 3
□ 4
□ 5
3. Students selected to attend the 2015 Health Career Exploration Symposium will receive a t-shirt. Please
indicate t-shirt size.
□ XXL
□ XL
□ L
□ M
□ S
A. DEMOGRAPHIC INFORMATION:
1. Name ________________________________________________________________________________
Last
First
Middle
2. Home Address _________________________________________________________________________
Street
&
No.
_________________________________________________________________________
.
City
State
Zip
3. Is your home address the same as your mailing address? □ YES
If no, please provide your correct mailing address below.
County
□ NO
Mailing Address ________________________________________________________________________
P.O. Box
_______________________________________________________________________
City
State
Zip
4. Age _____ Date of Birth ____/____/____ Place of Birth__________________________________________
Mo./ Day
5. Sex: □ Male
/ Yr.
City/County
State
□ Female
6. Home Telephone: (______) ______________________
Area Code
Cell Phone: (______) ______________________
Area Code
E-mail address: _________________________________________________________________________
7. Ethnicity:
Race (check as many as apply)
o
American Indian or Alaska Native
o
Asian
o
Black or African American
o
Hispanic or Latino
o
Native Hawaiian or other Pacific Islander
o
White or Caucasian
B. ACADEMIC INFORMATION
1. School Name: __________________________________________________________________________
2. School Mailing Address: __________________________________________________________________
______________________________________________________________________
City
3. Current Classification:
º High School:
State
□9
th
□10
th
Zip
County
□11
th
□12th
4. List any honors/distinctions received for scholastic achievements:
_________________________________________ __________________________________________
_________________________________________ __________________________________________
5. List any extracurricular and/or community service activities (EXCLUDING jobs held during your high
school/college years). Please INCLUDE any AHEC activities.
_________________________________________ __________________________________________
_________________________________________ __________________________________________
C. FAMILY:
1. Will you be the first family member to graduate from a college or university in your household?
□ YES
□ NO
D. PERSONAL STATEMENT: Why should the selection committee choose you as a participant in the 2015 Health
Career Exploration Symposium? (Please include your unique character traits, academic/career goals, and interested in
becoming a future healthcare professional.)
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
________________________________________________________________________________________________
EXTENDED APPLICATION DEADLINE: APRIL 10, 2015
Submit application, transcript, $5 application fee, and recommendation letter to:
Lowcountry AHEC
c/o Tracey Wilson
87 Academy Road
Walterboro, SC 29488
Program Contacts:
Katura Williams, MEd
[email protected]
843.782.5052(office)
Tracey Wilson
[email protected]
843.782.5052(office)
LT Chahn Chess, MPH
[email protected]
843.228.3958(office)