Healthcare Management Program Visit Form

Higher Education Network Visit Form

Regional Services would like to assist you in planning a successful visit to your local health administration program. Please provide us with the following information.

* = required field

Regent name:*

Regent area:

E-mail address:*

Name of RAC member conducting the visit (if visiting on behalf of the Regent):

Name of the health administration program to be visited:*

Date of function:

Estimated no. of students:

Send materials to:

Name:*
Title:
Organization:
Address:*

City:*
State:*
Zip Code:*

Upon receipt of this request, ACHE staff will send the appropriate material to conduct the visit. Please allow 10 days for your order to be processed. If you have any additional questions, please contact your regional director.

If you do not receive an e-mail confirmation that this information was received by Regional Services, please contact your regional director.

Click the "Submit" button below to send this request
to ACHE's Division of Regional Services.