I am available on these dates and times:
(**Draft must be submitted at least 1-2 business days before the paper or project is due at the school)
School Information (if applicable)
When I click "submit" below, this form will be delivered electronically to Leah Hill, Student Programs Specialist. This form must be received at least two weeks before requested observation date. If your request is approved, an observer orientation will be coordinated. Proof of either a current negative TB skin test or a negative chest X-ray performed in the last 12 months is also required for all approved observation experiences. Proof of either of these tests must be shared with Leah.
By checking here, I acknowledge that the above information is accurate. I also authorize that this completed form and any additional relevant information may be shared with Scottsdale Healthcare staff members for the sole purpose of networking and possibly fulfilling my request for observation. I also authorize that if I am requesting an area such as the NICU, ICU, Emergency Department, Operating Rooms, or SANE that I am eighteen years or older (due to safety, infection control, and confidentiality issues).