high school job shadow application High School Job Shadow Application Name* Address* Street Address City State / Province / Region ZIP / Postal Code Phone Number* Cell Phone Number* E-mail Address* School Name* Age* Anticipated Graduation Date* What season are you available to participate in the Job Shadow program?* Spring Summer Fall You may choose more than one, but please take into consideration your involvement with extracurricular activities.Please provide specific availability for shadowing (school breaks, days, times, etc.)* What healthcare fields are you interested in? Please list your top three preferences.*Do you have a specific placement site in mind? Please list your top three preferences.*Are you currently employed?*YesNoIf yes, where? Do you have transportation to and from the placement site? (This is a program requirement)*YesNoDo you have previous experience in the healthcare field?*YesNoIf yes, please list all previous healthcare experience by identifying the location, date, and nature of the experience.How did you hear about this program?* Please explain why you think you would be a good choice for the Job Shadow Program*Please explain your future and educational aspirations or goals.*Please provide a brief description about your involvement in school or community extracurricular activities.*By typing my name in this field, I certify that the information contained in this application is true and complete to the best of my knowledge.* PARENT INFORMATION: Please have your parent/guardian complete the following information, acknowledging your interest in participating in this program. PARENT NAME* Relationship to Applicant* Phone Number* E-Mail Address*