Bozeman Health Student Request

Bozeman Health Student Request

In effect until further notice:

We are unable to consider requests from unaffiliated programs unless a previous arrangement has been made with a Bozeman Health preceptor. If you are unsure about your school's affiliation status, please email students@bozemanhealth.org.
Individual observation requests will only be considered if a previous arrangement has been made with a Bozeman Health preceptor.

Thank you for your interest in gaining practical experience at Bozeman Health. In order to determine eligibility, the following information is needed.

We will make an effort to respond in a timely manner. If you do not receive a response within 2 weeks, please send a follow-up email to students@bozemanhealth.org.

If approved, you will receive an email requesting the required documentation. A list of documentation requirements will appear at the bottom of this page once the necessary fields are filled in.

Educational experiences are limited and in high-demand. It is recommended that program-required experiences be requested 6 months in advance of the anticipated start date. Requests submitted less than 30 days before the start date will not be considered.

Please note, all student experiences are unpaid.

I am completing this form on behalf of:*

Myself

Name of the person completing this form*

Email of the person completing this form*

What is your relationship to the student?*

Please complete the following information on behalf of the student.

Student Name*

Email*

Phone*

Phone

What is your affiliation with Bozeman Health?*

Select

Bozeman Health department and job title:*

How long have you been employed at Bozeman Health?*

Job Shadowing?

If you are a current Bozeman Health employee and are looking for an observation experience / job shadowing for the purposes of professional development or to fulfill an application requirement for a specific school or program, please submit a Job Shadowing Request Form instead of this form.

However, if this request is related to a requirement for a currently enrolled program or an academic, formalized course of study, please continue with this Student Request Form.

More information about Bozeman Health's Employee Job Shadowing program can be found here.

Still not sure? Email jeickman@bozemanhealth.org with questions.

How many hours have you volunteered at Bozeman Health?

What type of experience are you requesting?*

Please read the following descriptions before selecting the appropriate experience.

Clinical rotation: program-required, healthcare-specific practicum, internship, or externship; may include direct patient care

Non-clinical rotation: program-required practicum, internship, externship, or project; does not include direct patient care

Observation: not required for a currently enrolled academic program but may be required for a program application or to ascertain career interest; does not include direct patient care

Community professional: currently employed within a healthcare-related community organization and seeking an observation or hands-on experience within the scope of your employment

Select

What is the purpose of the student experience you are requesting?*

To fulfill a requirement of a program I am currently enrolled in

To fulfill an application requirement for a program I am applying to

To strengthen a school application

To assess my interest in a certain career field

Professional or organizational development (Community Professional)

Please provide documentation that clearly outlines program requirements

Drag and drop files here or

What programs/schools are you planning to apply to?

Observation Request*

Observation experiences are extremely limited. If approved, you will be expected to follow through with the student onboarding process within 30 days and communicate changes in a timely manner.

To be considered for an observation experience, please share your career goals and how an observation experience will contribute to your future plans.

Are you currently enrolled in an academic program?*

Select

What is the school/organization you are CURRENTLY enrolled in?*

What is the program you are CURRENTLY enrolled in?*

Matriculation in degree program*

i.e. 2nd year of 4, or sophomore

What is your anticipated date of graduation or program completion?*

month and year

Please provide details regarding your organization, program, and role.*

Academic coordinator's name (or school contact)*

Academic coordinator's email*

Academic coordinator's phone number*

Please check for accuracy

Phone

What department(s) or specialty area(s) are you requesting to work in?*

How many hours do you need to fulfill this request?*

Projected Start Date*

Requests submitted less than 30 days before the start date will not be considered.

Projected End Date*

Do you have a tentative commitment from a Bozeman Health preceptor?*

Select

Name of preceptor(s)*

What preceptor qualifications are you looking for?*

i.e., if you are an NP student, can your preceptor be a PA or MD, or NP only?

Please provide additional information relevant to this request.

Documentation Requirements Upon Approval

If this request is approved, the following items will be requested and must be submitted at least 30 days prior to the educational experience.

- Affiliation agreement, typically signed by the school/program*

- Proof of liability insurance, typically provided by the school/program*

- Comprehensive national background check report, current within the past 12 months

- Immunization record, including:

Hepatitis B
Measles, Mumps, Rubella (MMR)
Varicella (Chickenpox)
Tdap within past 10 years
Tuberculosis (TB) - negative two-step PPD skin test or QuantiFERON Gold (QFG) blood test within the last 12 months
Influenza (annual) if rotation occurs any time between October and April
COVID-19 (annual)

- Signed Computer Access Security Agreement

- Signed Confidentiality Commitment

- Student Position Statement

- Completion of Bozeman Health Orientation learning module with exam score of 85% or greater

- Copy of driver’s license or passport

- Headshot photo for Bozeman Health ID badge

- InPlace Network account ($40 license fee)

Certain clinical and provider student experiences may require additional documentation (i.e. BLS, professional license, resume, letter of good standing).

*Observation-only students do not require an affiliation agreement or liability insurance. All other items above are required.

Documentation Requirements Upon Approval (for current employees)

If this request is approved, the following items will be requested and must be submitted at least 30 days prior to the educational experience.

- Affiliation agreement, typically signed by the school/program

- Proof of liability insurance, typically provided by the school/program

- Signed Computer Access Security Agreement

- Student Position Statement

- InPlace Network account (license fee will be covered by Bozeman Health)

Certain clinical and provider student experiences may require additional documentation (i.e. BLS, professional license, resume, letter of good standing).

I have read and understand the documentation requirements outlined above.*

Please submit this request form by clicking the link below.

Send me a copy of my responses

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