Please complete this application form if you are interested in career shadowing/observation experience at Ascension Sacred Heart. Once you complete the form, click the Continue button at the bottom.


Eligibility:

Students 18 years of age and older who are undergraduates or seeking enrollment in a college or university with an interest in a possible healthcare career path.



Contact Information:


Have you received your COVID Vaccine?

The COVID vaccine is a requirement, if you do not wish to receive the vaccine you are ineligible to volunteer at this time.



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.



Emergency Contact

In the event of an emergency whom should we notify?




Sponsor:

Prior to beginning the Application process, the applicant must have a sponsor (associate or physician) that has already agreed to allow the applicant to shadow. Due to the large volume of requests, the Volunteer Office does not offer assistance in obtaining approval from a sponsor.



Criminal Background History & Consent

Have you ever been convicted of a crime and/or are there any legal charges pending against you?



Affirmation Statements

I agree to abide by all of Ascension Sacred Heart Health System policies and procedures which include the dress and appearance policy for observers. I agree that as I participate in the Career Shadowing/Observation program my role will be as an observer only and I will not be permitted to provide direct patient care or participate in any patient procedure.

At all times, I must be under the supervision of the sponsor. In addition, I understand that patients may exercise their rights to not participate in the Career Shadowing/Observation program.

I understand that in the course of my career shadowing/observation experience I may come into contact with confidential patient information. I will not at any time during or after my experience at Ascension Sacred Heart Health System disclose any patient information to any person or use patient information, other than necessary.

I understand that participation in this program is voluntary and without compensation and that Ascension Sacred Heart Health System is not responsible for any expenses incurred during, or as a result of, my participation in the Career Shadowing/Observation program.

In consideration for participation in the Career Shadowing/Observation program, I hereby waive, discharge and agree to hold harmless Ascension Sacred Heart Hospital, it's agents and employees from any and all liability, claims, demands, and actions arising out of or relating to any loss, liability, damage or injury sustained by me, or any property belonging to me while participating in the program.



Criminal Background History Consent & Statement

I hereby give my consent to conduct a criminal background history through the local county clerk of court records.
I understand that this information will be used to determine my eligibility for job shadowing at Ascension Sacred Heart Hospital.
I waive and release Ascension Sacred Heart and its agents from any and all claims I may otherwise have with respect to any such criminal background check.