Health Careers Institute Application 2020 2019-12-10T14:53:46-06:00

SWCAHEC Health Careers Institute Application 2020

June 6-9th, 2020 Cost: $200
  • Date Format: MM slash DD slash YYYY
    (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 guaranteed. *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 $200. 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 scholarships.
  • Date Format: MM slash DD slash YYYY
  • 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 Institute; 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.
    If you're paying by check, please mail or drop by a check for $200 to our office: 701 Camino del Rio, Suite 320, Durango, CO 81301, made out to SW Colorado AHEC. If you're paying through Eventbrite, the fee per $200 ticket is $11.14 and you will be redirected to the payment page once you hit submit. THANK YOU!
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