AHEC-SECU MOC Application
The Northwest Area Health Education Center (NW AHEC) in partnership with the State Employees Credit Union (SECU) invite providers in our seventeen-county catchment area to submit a proposal for one of ten small awards designed to promote improved care through telemedicine and remote patient monitoring. **To complete your application, please email your curriculum vitae to cjones@wakehealth.edu.
Questions marked with '*' are required to complete the survey.
1) *

2) Credential: *





3) *
4) *

5) What type of clinic are you applying on behalf of: *


6) Are you interested in conducting a Maintenance of Certification Project for your Specialty Board? Please select: *




7) What county is the clinic located in: *

















8) *
9) *
10) *
11) *
12) *
13)