Request for Shadowing/Observation of health care worker
Thank you for your interest in shadowing a health professional at HCC/Live Well Community Health Center. Please complete the following request. There are no guarantees that shadowing can be arranged but we will try our best to accommodate your requests.

REQUIREMENTS FOR SHADOWING
All students interested in shadowing must be at least 16 years of age or older. Students younger than 18 must have a legal guardian consent form stating that they can shadow at one of our facilities.

All students who are shadowing need to have the following immunizations/tests, before shadowing in our clinics:
 TB Test
 Flu Shot
 Immunization Records

These can be obtained at your local health department. If have questions or concerns or barriers to obtaining these please contact Chelse Bargfrede at chelse.bargfrede@hccnetwork.org.
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First and Last Name
Email
Cell Phone
High School / University
Current Age and date of birth
Dates available to Shadowing (you can put days of the week, times, etc.)
Areas you are interested in shadowing
Locations you are willing to shadow (click all that apply)
FOR HIGH SCHOOL STUDENTS: Are you involved in any sort of health career prep program? (HOSA, PLTW, Health Occupations, etc.)
FOR HIGH SCHOOL STUDENTS: Why makes you interested in a health career? What career fields are you exploring?
FOR COLLEGE STUDENTS: Are you enrolled in a pre-health track? If so, what is your major?
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