Mary Greeley Medical Center Job Shadow Request Form
Mary Greeley Medical Center (MGMC) is committed to providing students with a positive educational experience that will help them prepare for a career in healthcare.

A job shadow is defined as observation lasting no more than 24 (twenty-four) hours scheduled to take place over no more than a 6 week period.  Job shadow/student observation is not available on the Behavioral Health or Birthways units. Job shadows are accepted based on department availability to accommodate the request.

Student Responsibilities:
To ensure that our patients are protected and students are well prepared, we require students to complete organizational requirements prior to beginning their job shadow experience at MGMC.

Complete this form at least two weeks prior to the requested date. Your request will be forwarded to the unit(s) you are requesting and an HR representative will contact you with the accepting unit and additional information.

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Requester's Name: *
Phone: *
Email: *
Emergency Contact Name & Phone Number: *
School Affiliation: *
Education: *
Required
What year are you in school? *
Degree you are pursuing: *
Have you previously job shadowed at Mary Greeley? *
Required
If yes, date:
Department requested: *
If requesting a nursing job shadow, list your preferred area:
What is the purpose of your job shadow request?
Number of hours to be completed: *
Desired start date: *
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Desired end date: *
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Days and times available to do job shadow: *
Additional comments/requests:
Submit
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