College job shadow application College Job Shadow Application Name*Address*Cell Phone Number*E-Mail Address*School Name*Major*Anticipated Graduation Date*Age*Which season would you be 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, time, 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.*In 250 words or less, please let us know why you should be included in the Post-Secondary Shadow ProgramPlease describe all previous healthcare experience by identifying the location, date and nature of the experience.*Please explain your future short and long-term education and career goals.*I am a matriculated student of a health training program or health related major.* Yes No I am in good academic standing. Yes No 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.*