Shadowing Experience Application Home 5 Stay Connected 5 Shadowing Experience 5 Shadowing Application Form Shadowing Experience Application Your Name(Required) First Last Your Phone(Required)Today's Date(Required) MM slash DD slash YYYY Your Email Address(Required) Type of school you attend(Required)HighschoolCollegeIntended major/course of study(Required)Specific area you would like to observe(Required)Inpatient Physical TherapyOutpatient Physical TherapyInpatient Occupational TherapyOutpatient Occupational TherapyInpatient Speech TherapyOutpatient Speech TherapyInpatient Recreational TherapyInpatient Music TherapyPlease select a day/time you are available to observe. (Time slots open 2 months prior to month of shadowing.)Tuesdays 9:00am - 12:00amPlease select a day/time you are available to observe. (Time slots open 2 months prior to month of shadowing.)Tuesdays 1:00pm - 4:00pmPlease select a day/time you are available to observe. (Time slots open 2 months prior to month of shadowing.)Wednesday 9:00am - 12:00pm (once a month – first Wednesday of month)Please select a day/time you are available to observe. (Time slots open 2 months prior to month of shadowing.)Wednesdays 1:00pm - 4:00pmPlease select a day/time you are available to observe. (Time slots open 2 months prior to month of shadowing.)Thursdays 9:00am - 12:00pmPlease select a day/time you are available to observe. (Time slots open 2 months prior to month of shadowing.)Thursdays 1:00pm - 4:00pmTerms and Conditions(Required) I understand that this observation experience will be an unpaid experience and I will be required to complete certain paperwork prior to observing. “I still think about how Ranken Jordan changed my life.” — Kiland Sampa, Inpatient Jul-Nov 2013, Outpatient Dec 2013-Dec 2014
