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(Required) Your Email Address(Required) Type of school you attend(Required)HighschoolCollegeIntended major/course of study(Required)Specific area you would like to observe(Required)Select from list belowInpatient Physical TherapyOutpatient Physical TherapyInpatient Occupational TherapyOutpatient Occupational TherapyInpatient Speech TherapyOutpatient Speech TherapyInpatient Recreational TherapyInpatient Music TherapyInpatient Physical TherapyInpatient Physical Therapy Select Day/Time for Inpatient Physical Therapy(Required)Outpatient Physical TherapySelect Day/Time for Outpatient Physical Therapy(Required)Outpatient Physical Therapy Inpatient Occupational TherapySelect Day/Time for Inpatient Occupational Therapy(Required)Inpatient Occupational Therapy Outpatient Occupational TherapySelect Day/Time for Outpatient Occupational Therapy(Required)Outpatient Occupational Therapy Inpatient Speech TherapySelect Day/Time for Inpatient Speech Therapy(Required)Inpatient Speech Therapy Outpatient Speech TherapySelect Day/Time for Outpatient Speech Therapy(Required)Outpatient Speech Therapy Inpatient Recreational TherapySelect Day/Time for Inpatient Recreational Therapy(Required)Inpatient Recreational Therapy Inpatient Music TherapySelect Day/Time for Inpatient Music Therapy(Required)Inpatient Music Therapy Terms 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.Paperwork Consent(Required) I understand that after submitting this application, an automatic email will be sent with documents that must be signed and sent at least 2 weeks before the date requested. Until [email protected] receives these documents, this application request cannot be confirmed. If you do not automatically receive this email, please check spam folders or reach out to [email protected](Required) “I still think about how Ranken Jordan changed my life.” — Kiland Sampa, Inpatient Jul-Nov 2013, Outpatient Dec 2013-Dec 2014
