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NJ AHEC Scholars Program Application
Thank you for your interest in serving and learning about medically underserved communities in New Jersey! If you have any questions about the program you can reach out to Erin Lucas at Lucase@rowan.edu
Please complete the contact information below:
First name (legal name)
Last name (legal name)
Enter your preferred name
Date of Birth
Permanent Mailing Address
City
State
Zip Code
Mobile phone # (xxx-xxx-xxx)
Personal Email Address
School Email Address
Which age range do you currently fall within?
20-29
30-39
40-49
50-59
60 and over
What is your citizenship status? (AHEC Scholars must be either U.S. citizens or permanent residents with a green card)
U.S Citizen
Permanent Resident with Green Card
Other
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