Learning & Performance Shadowing Application

Learning & Performance Shadowing Application

Thank you for your interest in shadowing at Connecticut Children’s!

In order to shadow at the organization, please review the documents below for an overview of the CT Children's shadowing process and the information you must submit prior to start.

We will need to know the date(s) and location where you will be shadowing. Each department and role have a different allowance for the duration of a shadow experience. Most shadows last for 4-8 hours, but some can go up to 7 days, consecutively or non-consecutively. This will be determined by the department leader.

Please note: while CT Children's strongly encourages all learners to be vaccinated against COVID-19, we are not currently requiring proof of this vaccination prior to shadowing.

Please note: CT Children's requires proof of influenza vaccination between the months of October and March.

Once we have all of the above information, we will confirm you are set to begin your shadowing experience.

We look forward to having you with us in the near future! Please do not hesitate to reach out if you have any questions.

SHADOWING APPLICATION

First Name*

Last Name*

Date of Birth*

Shadow experiences in clinical or hazardous areas of the hospital have a minimum age requirement.

E-Mail Address*

Please enter a valid school/university email address.

School/University

Please enter the full name of your school or university.

SHADOWING DATE(S) AND LOCATION

Our team will need to know the date(s) and location where you will be shadowing for our records. Please note that CT Children’s allows students to shadow for a maximum of 7 days. The dates of your shadowing experience can be consecutive or non-consecutive.

Department Interested in Shadowing

Please select the department you are interested in shadowing.

Select or enter value

Please list a second option, if desired.

Your first choice may not be available. Let us know if you have another department you are interested in!

Select

Provider You are Interested in Shadowing

If you have a specific provider you are interested in shadowing, or if you have been in contact with a provider who has agreed to a shadowing experience, please enter their name here. If you do not know who you will be shadowing, please leave blank.

Shadowing Date(s)

Please enter the date(s) you expect to shadow here. Please note: learners may only shadow a maximum of 7 days. If you do not know the date(s) of your shadow, please leave blank.

INFORMATION AND FORM REQUIREMENTS

Please review the following documents prior to your shadowing experience. All completed forms should be returned at least one week prior to your visit to allow time for processing.

Please review, sign, and submit the following at the end of this form:

POLICY REVIEW

Please review the CT Children's Code of Conduct Policy, complete the certification form at the end of the policy, and submit at the end of this form:

Connecticut Children's Code of Conduct Policy

Please submit an electronic signature below confirming you have received and reviewed a copy of the CT Children's Workplace Attire Policy:

Connecticut Children's Workplace Attire Policy

Electronic Signature

By entering your full, legal name below, you are confirming that you have received and reviewed copies of the CT Children's Code of Conduct Policy and the CT Children's Workplace Attire Policy.

DAY OF VISIT

Please communicate with the individual you will be shadowing to arrange for an escort to the area you will be shadowing.

File Upload*

Below, you may upload signed copies of your:

Connecticut Children's Visitor/Observer Release Form
Connecticut Children's Confidentiality Agreement Form
Connecticut Children's Code of Conduct Policy
Proof of COVID Vaccination
Proof of Influenza Vaccination (Only October - March)

Drag and drop files here or

Send me a copy of my responses

Privacy Notice|Report Abuse