Shadow Program Application Options

Become a Health Care Leader of Tomorrow with our

Health Care Professional for a Day Summer Program

What you'll need to apply:

Photo Release / Approval Form
Click here to download the PDF form. Please complete this form, sign it, then upload it with the application as a PDF or JPG (less than 2mb).

* = Required Field

1:1 Shadowing Program Application

What you'll need to apply:

1. HIPAA Training Manual for Student Observers
Click here to download the PDF HIPAA Manual. Read and understand the tutorialcall or contact us if you have any questions.

2. Shadowing Program Confidentiality HIPAA Form
Click here to download the PDF form. Please complete this form as an acknowledgment of HIPPA confidentiality, sign it, then upload it with the application as a PDF or JPG (less than 2mb).

3. Observer-Sponsor Acknowledgement Form
Click here to download the PDF form. After reviewing, please fill in and sign the "Observer Name" and "Signature" only, then upload it with the application as a PDF or JPG (less than 2mb).

4. Two paragraph essay explaining why this experience will be important/relevant to you.
You may want to give some thought to your two paragraph essay before you begin the application form.

Contact Information

Have you previously applied for, or participated in, the Summit Medical Group Foundation Shadowing Program? *

Parent/Legal Guardian Name & Emergency Contact Info
Preferences

Please indicate which day you are available to participate in the Health Care Professional for a Day Summer Program event. *

If you are approved to shadow a doctor for one day which area(s) of medicine do you prefer?

Please indicate which weeks you are available to participate for a one day shadowing experience. *

Resume and Essay

Upload a resume

Required Documents

Upload Signed "Photo Release/Approval" form *
(* jpg or pdf accepted. File must be less than 2MB in size)

Upload your signed "Shadowing Program Confidentiality HIPAA" Form *
(* jpg or pdf accepted. File must be less than 2MB in size)

Upload your signed "Observer-Sponsor Acknowledgement" Form *
(* jpg or pdf accepted. File must be less than 2MB in size)

Additional Notes and Questions

Note: Transportation to/from the SMG campus is not provided. Lunch and snacks will be offered to the participants on the day of the event.

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