TA - Shadowing and Internship Request

Are you employed by MVHS?

Employee Number:

Full Name

Date Hired

Department Name

Email Address

Phone Number

School Currently Attending

Current Major

Supervisor Name

Requester's Name:

Requester's Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Requester's Email:

example@example.com

School Currently Attending:

Current Major:

Are you 18 years or older?

Are you a high school student in at least grades 11 or 12?

There are limited shadowing opportunities for juniors and seniors in high school. Someone will be in contact with you to review your options and explain the requirements.

High school students are invited to take part in one of our comprehensive tour experiences. Unfortunately, shadowing within a department is not available to high school students prior to their junior year.

Are you enrolled in an official job shadow or internship program?

Please provide the name and a brief description of the program.

Please note that students not enrolled in a formal program may be limited to the amount of time they can shadow.

Are you asking for this opportunity as part of "credits" towards a course or curriculum?

Please provide the number of hours you are requesting and any details about your program.

Please note that unless a student is requesting a "for credit" or "paid" work experience, the number of hours may be limited. All requests are reviewed on a case by case basis.

Are you asking for this opportunity to be paid for by MVHS?

There are times when a department is willing to pay a student to do a formal internship experience. These are reviewed on a case by case basis.

Please note that unless a student is requesting a "for credit" or "paid" work experience, the number of hours may be limited. All requests are reviewed on a case by case basis.

Will this experience be paid for by someone other than MVHS as part of a formalized program?

Please provide the number of hours you are requesting and any details about your program.

Please note that unless a student is requesting a "for credit" or "paid" work experience, the number of hours may be limited. All requests are reviewed on a case by case basis.

What department(s) are you requesting to shadow/intern? Please list up to 3 in order of your preference.

Please note: The Emergency Department, Operating Room, and Behavioral Health, and other procedural areas, are considered on a case by case basis.

Have you already been in contact with someone who works in the department you are interested in shadowing? If so, please provide the contact's name.

Are you related to the person you want to shadow?

Ideally, how many hours are you requesting to shadow/intern?