Home / Pre-med Shadowing Request

Pre-med Shadowing Request

Name: Kootenai Health
Price range: $

This is an opportunity for qualified college students to job shadow our healthcare professionals in order to meet the requirements for medical school applicant. Students must be enrolled in a formal education program and be in good academic standing. This is an unpaid experience and students may spend 40 hours within Kootenai Health, it is recommended that shadowing be limited to 2 days per specialty. Shadowing is not permitted in the main Kootenai Health Operating Room. Applicants must make their own arrangements with a Kootenai Health provider for shadowing times. Applications must be received 4 weeks prior to the requested date.

Name

Current Address

City

State

Zip

Phone

Email Address

Permanent Address

Permanent City

Permanent State

Permanent Zip

Emergency Contact Name

Emergency Contact Phone

Shadowing Date & Time Requested

GPA

School

Major

Have you ever been convicted of a felony?YesNo

Observation Arrangements

I have made arrangements with a Kootenai Health physician and been approved for an observation experience

Physician Name

Physician Title

Physician Department

Physician Phone

Physician Email

Confidentiality Statement

As a student considering a career as a health care professional, I understand the importance of confidentiality and pledge to observe appropriate rules of conduct and maintain confidentiality before, during, and after my shadowing experience at Kootenai Hospital / Kootenai Clinic, and will uphold the standards within the profession.

I have read and agree to the Confidentiality Statement above.

I release Kootenai Hospital / Kootenai Clinic of any liability while I am on hospital grounds.

I verify that I have the following up-to-date immunizations: measles, mumps and rubella (MMR); chicken pox (varicella) or history of the disease; and tetanus / diphtheria.

Typed Name (electronic signature)

Type your full legal name to electronically sign this acknowledgment.

Academic Advisor Request

Your academic advisor should separately provide: (1) a brief letter of recommendation stating the student's academic standing, and (2) a statement of the academic necessity of the student's request for a shadow experience. Please return to: Amanda Junttila, Medical Education Coordinator, ajunttila@kh.org, (208) 625-6029.