Application for Hearing Care Professional Student Placement
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Are you legally able to work in Canada
*
Yes
No
Please select what type of opportunity you are seeking
*
Please Select
Job Shadow
Practicum Placement
What geographical region(s) would you be interested in for your placement?
*
Vancouver Island, BC
Metro Vancouver, BC
Other BC Locations
North Alberta
South Alberta
Saskatchewan
Manitoba
Greater Toronto Area, ON
Ottawa, ON
Other Ontario Locations
New Brunswick
Nova Scotia
Prince Edward Island
Other Remote or Rural Locations across Canada
Do you speak any languages other than English?
If there is are any specific Connect Hearing locations that you prefer, please list them here. (a full list of our clinics can be found at connecthearing.ca)
*
Are you studying to become a Hearing Instrument Practitioner / Specialist or an Audiologist?
*
Hearing Instrument Practitioner / Specialist
Audiologist
How many practicum hours do you require?
*
When would you like to begin your placement?
*
-
Month
-
Day
Year
Date
Are you interested in being contacted in the future for job oportunites?
*
Yes
No
Tell us a little about yourself or what has drawn you to our industry. (optional)
Submit
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