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MASK POLICY UPDATE: FACE COVERINGS ARE NOW ONLY REQUIRED IN OUR SURGERY CENTER.

Medical Mentoring Application

Student Information

Name
Address

Parent/Guardian Information

Name
Address

What are your current plans after high school?
Physician
  • Orthopedic Surgeon
  • Physiatry
  • Primary Care
  • Pediatrician
  • Radiologist
  • Anesthesiologist
  • Podiatrist
  • Optometrist
  • Dentist
  • Ear, Nose & Throat Specialist
  • Orthopedic Spine Surgery (patients in clinic)
  • Neurosurgery (patients in clinic)
Mid-Level
  • Nurse Practitioner
  • Registered Nurse
  • Physical Therapist
  • Occupational Therapist
  • Orthotist
Technician
  • Surgical
  • Radiology
  • Phlebotomy
From the list above, please list your top 3 career interests. (#1 being your top choice)
The choices below are a guidance for your home base location where eight hours of shadowing will be offered. You will be given the opportunity to shadow in numerous other areas that are not on the above list (for example, pharmacy, oncology, dietician...).
List
1
2
3

Max. file size: 8 MB.

Student
Parent
Parent