Student Job Shadowing Request Application

All students at St. Luke’s must be covered by an Affiliation Agreement between St. Luke’s and the student’s college/university.

Requests for observation/shadowing are reviewed monthly. Please allow four weeks for processing of requests.

Observation/shadowing placements typically last four to eight hours, with the exception of college credit observation hours. Placement for observation/shadowing is not guaranteed.

Email a copy of your completed form to [email protected] or mail the printed form to Robin Hutchinson, Education Department, St. Luke’s, 915 E. 1st St. Duluth, MN 55805.

For more information, please contact Robin Hutchinson, Education Department at the email above.

Part 1: Contact information

First name: ______Last name: ______Address: ______City: ______State: ______Zip Code: ______E-Mail address: ______Phone number: ______Cell phone number: ______

Part 2: Job Observation/ Shadowing Information

Are you a current St. Luke’s employee? ______Reason for observing/shadowing? ______College/University: ______Instructor name: ______Instructor contact information: ______Please describe in detail your area of interest (Specific field such as MD, RN, PA, etc with specific specialty, specific clinic/provider): ______St. Luke’s facility in which you would like to shadow: ______Have you made prior arrangements with a St Luke’s employee for this observation/shadowing request? ______If yes, please provide name, department, and contact information: ______Specific date(s) and time(s) desired for this experience: ______Number of hours needed to fulfill request: ______