Parkview Education Services  |                                  Job Shadow Request Form
The information you submit will allow Parkview Health Education Services to match a student with a job shadow in our system of healthcare opportunities. Job shadows are hands-off, limited time learning opportunities that may take place up to 8 hours per day; can be multiple days not to exceed 1 week.

Submitting a request does not guarantee your placement in one of our learning opportunities.
     - All requests MUST BE MADE FOR A STUDENT pursuing a diploma, certificate, credential, or degree.
     - All requests MUST BE SUBMITTED A MINIMUM OF 60 days prior to the date of the learning experience.
     - All placed students MUST COMPLETE AND RETURN THE ATTESTATION FORM no less than 30 days prior to start of the learning experience. All students must provide proof of vaccinations, TB test, and other documentation in order to be be placed in a learning experience.

Process for job shadow placement:
  1. Requests for a job shadow must be made online using this request form. 
  2. Once your online form submission is received, you will receive a receipt of your request which will include the required Attestation Form you must complete and return within 30 days. Your placement request will not be processed until we receive your completed Attestation Form.
  3. Once you return the completed Attestation Form, our Student Experience Consultant will work to secure your job shadow placement. If you have a specific person or department you want to shadow, please be sure to indicate it on the form. 
  4. Confirmation of placement including the date, time, and location will be sent to you two weeks after we receive your completed Attestation Form. If we are unable to secure your specific date request, we will provide our best alternative date(s) in your desired area.
Questions? Contact Students@parkview.com and IN THE SUBJECT LINE include "Job Shadow Question" and name of your school.

Due to the volume of Job Shadow requests, response times may be delayed.
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Who is completing this form? *
Please confirm you you requesting a Job Shadow experience (hands-off, short-term experience)

If you want to request an internship, clinical, or other hands-on learning experience, please complete our Request for a Learning Opportunity Form.
 *
Your Full Name (First Name, Middle Initial, and Last Name) *
Your Email *
Your Phone Number *
Grade Level of Student(s)
(Check all that Apply)
 *
Required
Age of Student(s)
(Check all that apply)
NOTE: Students aged 18 years and over will be required to complete a background check as part of the Attestation Form
 *
Required
If the student is a Parkview Co-worker or existing Parkview Student, please include your E or S number
Your School's Name *
Is this job shadow a requirement for a class/course at your school? *
Which of the following areas are you interested in shadowing in? At ths time, only the areas listed below are available for shadow experiences. *
What Parkview location(s) are you available to go to for the Job Shadow? (Check all that apply) *
Required
Do you have a specific Parkview co-worker or physician you would like to shadow/observe? If yes, please provide their name and your relationship to them in the box below. If no, please leave blank.
CLICK SUBMIT TO COMPLETE REQUEST
Submitting a request does not guarantee your placement in one of our learning opportunities.
     - All requests MUST BE MADE FOR A STUDENT pursuing a diploma, certificate, credential, or degree.
     - All requests MUST BE SUBMITTED A MINIMUM OF 60 days prior to the date of the learning experience.
     - All placed students MUST COMPLETE AND RETURN THE ATTESTATION FORM no less than 30 days prior to start of the learning experience. All students must provide proof of vaccinations, TB test, and other documentation in order to be be placed in a learning experience.

Process for job shadow placement:
  1. Requests for a job shadow must be made online using this request form. 
  2. Once your online form submission is received, you will receive a receipt of your request which will include the required Attestation Form you must complete and return within 30 days. Your placement request will not be processed until we receive your completed Attestation Form.
  3. Once you return the completed Attestation Form, our Student Experience Consultant will work to secure your job shadow placement. If you have a specific person or department you want to shadow, please be sure to indicate it on the form. 
  4. Confirmation of placement including the date, time, and location will be sent to you two weeks after we receive your completed Attestation Form. If we are unable to secure your specific date request, we will provide our best alternative date(s) in your desired area.
Questions? Contact Students@parkview.com and IN THE SUBJECT LINE include "Job Shadow Question" and name of your school.

Due to the volume of Job Shadow requests, response times may be delayed.
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