Home
Job Shadow/Clinical Rotation Request Form
Job Shadow/Clinical Rotation Request Form
New Request
UPMC Western Maryland proudly supports students completing healthcare academic programs through clinical rotations as well as individuals seeking additional information about healthcare careers by offering job shadowing opportunities.
To be considered for either a clinical rotation or a job shadowing opportunity, interested individuals will need to complete the Job Shadow/Clinical Rotation request form.
After completing the request form, you will be notified by WMHS regarding the status of your request.
Job Shadowing opportunities can be no more than a total of 8 hours.
If approved for either a clinical rotation or a job shadowing opportunity, you will need to provide the following information before you will be able to start:
Immunization Record (link to list of immunizations)
Completed Handbook Acknowledgment (link to handbook)
Confidentiality Form (link to form)
*Those interested in job shadowing must be at least 18 years old.
**Shadowing is not available in Behavioral Health, Labor & Delivery, or Obstetric units.
For Clinical Rotations
We strongly encourage students to apply ASAP, preferably 6-9 months in advance. We have established priorities for who and how many requests we can fulfill at one time. For example, we strive to meet requests from our employees and our local colleges/university first. Therefore, we cannot guarantee that we can fulfill your request and you will be notified in a timely manner with our decision.
Job Shadow/Clinical Rotation Request Form
Are you currently employed by WMHS?
Yes
No
Please enter the following information:
Name:
Phone #:
Email Address:
Please select
one
from the following:
I’m interested in learning more about Healthcare Occupations
I’m seeking a rotation at WMHS as part of a requirement of my educational program
Are you currently enrolled in one of the following educational programs?
Please select
one
area of study.
Nurse Practitioner
Physician Assistant
Medical Student
Resident
LPN-RN
RN-BSN
BSN to MSN
Social Work
Psychology
Marketing
Finance
Other
Anticipated start date:
Anticipated end date:
Days of the week preferred:
Months preferred:
# of Days/Weeks:
Please list the Healthcare Professional titles you are allowed to work with:
Please list the speciality you are seeking for the clinical rotation:
Name of School:
School Contact name:
School contact phone #:
School contact email address:
Total hours needed to complete rotation:
Any special requests? (ex. Max # of preceptors allowed):
Are you requesting multiple rotations? If Yes, please submit a request form for each rotation needed.
Type in the text:
