Biomedical Scholars Shadowing

Clinic Name

Clinician Name

Clinician Profession

Street AddressClinic Address

CityClinic City

StateClinic State

ZIP/Postal CodeClinic zip

CountryClinic Country

Clinic Phone

Clinician Phone, if phone contact is preferred

Clinician Email, if email contact is preferred

The 2018 Biomedical Scholars Shadowing Bootcamp will be August 5-16, 2018. Are you available to host a shadowing student during Bootcamp?

Yes

No

Are you comfortable hosting two Biomedical Scholars at the same time?

Yes

No

What will be the best way for Dr. Ruth Plymale to contact you, to schedule shadowing during Bootcamp?

Clinic Phone

Clinician phone

Clinician email

Are you available to host a Biomedical Scholar for shadowing during the 2018-2019 academic year?

Yes

No

What will be the best way for students to contact you, to schedule shadowing hours?

Clinic phone

Clinician phone

Clinician email

Are you available to host any pre-health profession Ouachita Baptist University student for shadowing during the 2018 summer and/or the 2018-2019 academic year?

Yes

No

What will be the best way for students to contact you, to schedule shadowing hours?

Clinic phone

Clinician phone

Clinician email