(all cities and towns in the Southwest region are considered rural).
(All communities in the 8 county SWCAHEC region are considered "medically-underserved areas")
We will try very hard to place you in your first or second choice for a shadow site, however, this cannot be guarenteed. *Please note that local OR's are not allowed to have students shadow in operating rooms.
I certify that the information given in this application is true & correct. I have proofread for accuracy and completeness, for I realize that applications are accepted only when complete.
I understand that tuition for the camp is $375 plus a $18.49 Eventbrite service fee if paying by credit card on Eventbrite. Or I may close out of Eventbrite and call the executive director to pay by Square credit card for a $10.31 Square service fee; In lieu of credit card payments, I may pay by check. By initialing, I indicate my understanding, that upon acceptance into the program, my son/daughter is required to provide a copy of their up-to-date immunization records. I also understand that I can contact the Executive Director for information about camp scholarships.
By entering name and date above and clicking the "Submit" button below I certify that: 1) I will not hold the Colorado AHEC Program or Southwestern Colorado Area Health Education Center responsible for any accidents that may occur while my son/daughter is participating in the program or at the job shadow site during the Health Careers Camp; 2) I am the custodial parent(s) and/or legal guardian(s) of the person designated as Participant above; and 3) I am over the age of eighteen (18) years of age.
This action will constitute an electronic signature in lieu of an actual signature and evidences the parties' mutual intent to enter into a valid and binding contract that will satisfy all applicable legal requirements. This Agreement shall constitute an "original" when printed from electronic files or records established and maintained in the normal course of business.
*You have several payment options: 1) Pay by credit card on the Eventbrite site - Eventbrite will charge a $19.44 service fee; 2) Call in to our office to pay by Square with a card- Square charges a $13.13 service fee; or bring your credit card in to our office and the fee is $10.31; 3) Mail or drop by a check for $375 to our office: 701 Camino del Rio, Suite 316, Durango, CO 81301, made out to SW Colorado AHEC. Questions about possible scholarship opportunities can be directed to Kathleen, 970-426-4284. If you are paying by check or need to discuss payment options, simply close out of the payment page. Thank you and we look forward to seeing you!
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