Georgia AHEC Student Support Form

Filling out this form is mandatory for all students participating in our credentialing program.


1. Download the XLS file below. You will need Excel or a similar program to open the file. If you don’t have this software, you may wish to try Open Office, a free alternative to Microsoft, or Google Drive.

2. Fill out the form. Make sure to complete every field.

3. Save the document. If you’re using something other than Excel, make sure your saved file has the .xls extension. If you’re in Google Drive, choose “Download As… Excel Spreadsheet (xlsx).”

4. Upload the file. Use the form below.

Download the form (XLS)

Upload your file

    Your Name

    Your Email

    Contact Phone Number

    Upload your completed form

    Having trouble with the XLS sheet? Click here to download the form as a PDF. You can type most information directly into the file, then simply print it out and mail to Blue Ridge Area Health Education Center (AHEC), 7 Ivy Street, NE, Rome, Ga, 30165. Or scan it and submit via the form above. You can also fax to 706-378-3113.