Shadowing Interest Form

Shadowing Interest Form

If you are interested in Shadowing at St. Bernards, please answer the following questions.
Requirements to shadow: You must meet the grade requirements below. If shadowing during winter months (October-March), you must present proof of current flu vaccination to shadow.

The amount of time allowed for shadowing:
- Jr. High and High School students – 2 hours
- College students – 4 hours
Age Requirements for Shadowing:
- Non-patient Care areas – 8th grade and above
- Most Patient Care areas – 10th grade and above
- Emergency Department – 12th grade and above
IMPORTANT: To allow as many opportunties for others, please select only one date. We limit shadowing opportunities to one per month.
Name*

First NameLast Name
School:
Please list your school if you're a student
Age: *
Current Grade in School

High School: 8th-9thHigh School: 10thHigh School: 11thHigh School: 12thCollege
Email*
example@example.com
Phone Number:*

Area CodePhone Number
Please Select the Department(s) you wish to shadow (See above age requirements for the departments you can shadow):*

AccountingCancer Care ServicesBio-Medical EngineeringCardiac ServicesCodingCommunity EducationCredentialingDietitiansEngineering/Facilities Mgmt.Healthcare AdministrationHuman ResourcesInformation Systems/TechnologyLaboratory SciencesMarketing/Public RelationsMedical RecordsNuclear MedicinePathologyNursingPharmacyPhysical TherapyRadiology (8am-12 pm only)Respiratory ServicesSenior Health ServicesSocial Work/Case ManagementTalent Acquisition/RecruitingOther
Day/Time You Wish to Volunteer (Please note that this does not confirm the date as the department must first verify they are available for requested date):*
Please submit proof of your Flu Vaccination (only needed if shadowing during the winter months - October-March):

Browse Files
Can be a JPEG, PDF, GIF, PNG format. Cancelof
Once you submit this information, we will be reaching out with further details. Thank you for your interest in shadowing at St. Bernards.
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