Healthcare Observation Experience - Application

To apply for an observation experience at Community Health Network, please complete the form below, including ALL documentation.

  • Applications must be complete for consideration.
  • To qualify, you must be at least 16 years old and a junior in high school.
  • A Community representative will contact you to confirm approval of your application. Please do not proceed onsite until you receive confirmation.

A healthcare observation experience is intended to provide exposure to student learners in a healthcare environment, allowing them to determine level of interest in healthcare careers.

An observer accompanies healthcare staff through their daily routine, observing and discussing experiences with doctors, residents, therapists, nurses, and other healthcare staff.

Observations may be for school credit or not for credit. Observations are standardly scheduled for 4 hours, but may be scheduled for up to 20 hours at the department's discretion. An observation longer than 20 hours requires the observer to complete additional requirements and is at the department's discretion.


Note: Some areas require a secondary choice of observation area. Please select area to see additional options.

Let us know any other relevant details about your request, such as preferred location/department/unit, caregiver to observe, etc.

Only one observation area can be requested per application. An observer is limited to submitting two applications to different areas with a maximum of four hours per observation.

Personal Information

Name
Address

Emergency Contact

Areas of Interest

Select up to 3 areas of interest:
(Only for Alexandria-Monroe High School students.)

Day and Time Preferences

Choose preferred days to observe:

Required Documentation

Alexandria-Monroe High School students must have the following kept on file by the school:

  1. Photocopy of your photo ID
  2. Evidence of immunization or titer for:
    1. MMR (measles, mumps, rubella)
    2. Varicella
    3. Hepatitis B or signed declination form
    4. Proof of negative TB test within last 12 months
    5. Flu vaccine for current flu season
    6. COVID-19 vaccine
  1. Photocopy of your photo ID
  2. Evidence of immunization or titer for:
    1. MMR (measles, mumps, rubella)
    2. Varicella
    3. Hepatitis B or signed declination form
    4. Proof of negative TB test within last 12 months
    5. Flu vaccine for current flu season
Maximum 7 files.
2 MB limit.
Allowed types: pdf, doc, docx, txt, rtf, jpg.

Acknowledgments and Signatures

Student Confidentiality and Non-Disclosure Agreement

This Confidentiality and Non‐Disclosure Agreement (this “Agreement”) is entered into by and between Community Health Network facilities (“CHNw”) and the student named below (“Student”).

  1. The Student is participating in an observation of healthcare services at a CHNw facility and Student may have access to confidential and proprietary information of CHNw and its patients, including but not limited to medical records, financial records, policies, procedures and strategic plans (the “Confidential Information”).
  2. CHNw requires assurances that the Confidential Information will not be used or disclosed by Student as a condition of participation.
  3. Student acknowledges the value and importance of protecting the confidentiality of the Confidential Information and agrees to use his/her best efforts to protect the Confidential Information.
  4. Student further agrees that he/she will:
    1. Hold the Confidential Information in the strictest confidence and will exercise at least the same care with respect thereto as he/she exercises with respect to his/her own most confidential or proprietary information.
    2. Not, without the prior, written consent of CHNw copy the Confidential Information other than as directly necessary for the achievement of the purposes of the observation or disclose any portion of the Confidential Information or any information derived from the Confidential Information to any person (including family members) who is not directly involved in the matters related to the Confidential Information; and
    3. Not use any portion of the Confidential Information or any information derived from the Confidential Information except for participation in the observation.
  5. Any violation of this Agreement will result in the immediate termination of the observation and may preclude Student from participating in any future observation opportunities at a CHNw facility.
Sign in the box below.
Sign in the box below.

When your application is complete, please press "Submit Application" ONE time. If the submit is successful you will go to this page with a confirmation message at the top: https://www.ecommunity.com/careers/observation-student-opportunities.

If you do not go to the confirmation page, please check that you have filled out ALL required fields in the form above and submit again.

A Community representative will contact you to confirm approval of your application. Please do not proceed onsite until you receive confirmation. Thank you!