Pre-Health Professions Club Shadowing Form

Looking for Pre-Health Professional shadowing? This form is to help us know what you are interested in so that we can place you in a setting most advantageous to your desired healthcare goals.

All fields marked with asterisk (*) are required.

required text field

Name (First, Middle Initial, Last)*

(First, Middle Initial, Last)

required text field

Healthcare Profession of Interest*

required text field

Setting of Interest*

(i.e. outpatient clinic, dental office, veterinary hospital, physician office, pharmacy, etc)

required textarea field

What is your shadowing availability? (time must be in at least 2-hour blocks, not overlapping with a lunch hour. For example 11-1 would not be good block of time.)*

Include day of week and times (e.g. Monday, Friday: 1:30-5:30pm, Thursday 8:30-10:30am)

textarea field

Prior Shadowing Experiences (if any)

Please include the location/facility and number of hours completed at each.

Link (required)