Lakeland Health Care

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Observer Application Form

Please review and complete the form below, and be aware that there may be a 2 week lead time required for certain observational experiences.



* Indicates required information
Name * 
Email Address * 
Phone * 
Street Address * 
City * 
State * 
Zip * 
School * 
Expected Graduation Date 
I understand I can only observe for a maximum of 16hrs, unless I have documentation that states otherwise * 
Number of observation hours requested * 
Please indicate facility preference * 
List desired dates for observational experience - 1st pref * 
Time of day you wish to observe * 
List desired dates for observational experience - 2nd pref 
Time of day you wish to observe 
Please indicate up to three health professions you are interested in shadowing. * 









If Other, please specify:

If you selected "Laboratory" above please specify which department 
If you selected "Registered Nurse" above please specify which department 
If you selected 'Radiology" above please specify which department 
Have you previously participated in Lakeland HealthCare's Observation Program? If so, when and where? 
Additional Comments 
Authentication * 

If the challenge words are too difficult to read, click here to refresh.
 

If you are under the age of 18, you must present the signed Parental Consent for Observation form.
Please note: your application will be reviewed and you will receive a response within 7 to 10 business days.

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    Lakeland Medical Center, St. Joseph  
    Lakeland Hospital, Niles  
    Lakeland Hospital, Watervliet  
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