Please complete this application form if you are interested in Shadowing at UofL Hospital. Once you complete the form, click the Continue button at the bottom.


Name and address


Demographic Information

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.



Availability

Shadowing Opportunities are Mondays through Fridays 8:00am -12:00PM. Please indicate the day(s) that you would like to shadow. *Note job shadowing is based on staff availability. It's recommended that you provide optional dates.



Emergency Contact


School Information


Areas of Interest

Choose 3 of the following areas you would like to shadow:



Pharmacy, Radiology, Lab/Phlebotomy, Physical Therapy, Occupational Therapy,Respiratory Therapy, Emergency Room, Operating Room, Cardiology, Oncology, Labor and Delivery, Nursing, and Social Services.




Facility You Would Like to Shadow

Please indicate which facility you would like to shadow:


UofL Hospital

Jewish Hospital

Mary & Elizabeth Hospital

Shelbyville Hospital



I understand and agree that submitting this application does not automatically register me to job shadow, and that certain qualifications must be met before I can actually start.


By submitting this form, I attest that the information I have provided on the form is true and accurate. I understand and agree that falsification of this or any other information is grounds for dismissal.