Submit this form to request a learning experience at a location in the Northwest Wisconsin region of Mayo Clinic Health System.
Contact Medical Education at firstname.lastname@example.org or call 715-464-2224 with questions about completing the form or the program.
If submitting this form on a laptop or desktop computer, use Google Chrome or Microsoft Edge, as other browsers are not supported. Be sure to follow the instructions and hints provided. You'll receive a confirmation page and email if the form has been successfully submitted. If you don't receive a confirmation, try clearing your browser, and completing and submitting the form again.
NP and PA students: Do not submit this form. Visit the Nurse Practitioner Clinical Education Collaboration Program website or Physician Assistant Clinical Rotation Program website for rotation opportunities.