Job Shadow Application

Complete this form to request a job shadow experience at Mayo Clinic Health System in La Crosse or other locations in Southwest Wisconsin.

Personal Information

First Name

Last Name

Address

City

State

Zip Code

Telephone

E-mailDouble check your entry for proper email address.

College and Program Information

College Name

Current Year in College

Class or Program Name

Status in Class or Program

Program Applicant (need shadow hours as part of my application)

Program Student (enrolled in the program and need hours to graduate)

Instructor's Name

Instructor's E-mail

Shadow Experience Request

Department you wish to shadowInclude 1-2 areas and be as specific as possible.

Position you wish to shadow

Number of hours needed (maximum is 8)

Date RangeMust be completed during this time and start date must be a minimum of 30 days from submission of this form.

Other information you can provide to support this request