If you are interested in other student opportunities such as job shadowing, volunteering, or preceptorship experiences, please submit an inquiry here. When you submit this form, it will not automatically collect your details like name and email address unless you provide it yourself.
Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Phone
(Required)
Email
(Required)
School or Institution
(Required)
Area (s) of Interest (Select up to 3)
(Required)
Urgent Care
Imaging
Behavioral Health
Specialty Clinics
Pharmacy
Lab
Nursing Education/Clinical support
Rehab
Administrative/non-clinical
Other
Please select 3 options.
Other
Type of Experience You Are Requesting
(Required)
Job Shadowing
Volunteering
Clinical Preceptorship
Other
Availability
(Required)
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Preference Start and End Date
(Required)
Briefly explain why you want to shadow/volunteer/precept at Cooper Green
(Required)
Additional Questions or Comments
By Submitting this form, I understand that completing this form does not guarantee placement and that all requests are to be reviewed by our HR team.
(Required)
I acknowledge