Job Shadow Application - Physician

Thank you for choosing Covenant HealthCare for your job shadowing experience. We have many excellent learning opportunities available. You will be given the opportunity to spend up to one day shadowing a health care professional. (The hours for job shadowing experiences can be extended at the department's discretion.)

For visiting medical students, please contact Angela Appold at 989.746.7504 or by email at


Phone Number

Email Address




ZIP Code

In which department will you be job shadowing (if already known)?

Which physician will you be job shadowing (if already known)?

Please describe your interests in healthcare and why you want to job shadow.

By signing in this box, I confirm that I have read and understand the above information. Your name shall have the same force and effect as your written signature.

Signature Date

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