Career Exploration
Student Observer Application

Welcome to the Logan Health Career Exploration Application! You’re just a step away from discovering an exciting career path!

To ensure a smooth process and prevent delays, please complete your application accurately.

Please keep in mind that during peak seasons—like spring break, summer vacation, and winter break—processing application forms may take up to one month.

If you are under 18, don't forget that your legal parent or guardian must complete the Minor Observer Agreement and upload it with your application. This step ensures that you can take full advantage of the experience we offer!

First and Last Name

Email Address

Phone Number

Include phone area code.

Date of Birth

mm/dd/yyyy

Are you under 18 years old?

If you are under 18, your legal parent or guardian must complete the Minor Observer Agreement and upload it with your application.

**You must be at least 16 years of age to observe in our facilities.

YES

Emergency Contact

In case of emergency, please provide emergency contact name and phone number.

Have you previously observed at Logan Health?

YES

If you are a Logan Health employee, which department do you work in?

If you are a Logan Health Employee, are you enrolled in an academic program?

Yes

Which Logan Health facility are you interested in observing?

Departments that you are interested in observing:

List your top two specific departments that you are interested in observing in order of preference.

Understand that some areas may not be available during your observation period.

What professional role are you interested in observing?

Is there a specific person(s) you wish to observe? Please list their name(s) here.

SCHEDULING: Dates you are available to observe:

Please provide at least five dates and times when you are available.

The options should extend over a three-week period, offering ample time to explore the best possibilities.

Your first date of availability should be no sooner than two weeks from today.

To ensure optimal results, please allocate at least four hours.
Early morning start times are the most effective option for maximizing opportunities.

Example:

05/08/2025 from 7 AM to 12 PM
05/15/2025 from 1 PM to 6 PM

Agreement to Policies

By typing my full name, I agree that I will abide by the following Logan Health Policies:

I attest that I will stay home if sick? Y/N

Yes

I am a known positive TB (tuberculosis) responder or have had a positive TB test.

Yes

Immunosuppression

This includes HIV infection, organ transplant, treatment with a Tumor Necrosis Factor (TNF) - alpha antagonist (infliximab, etanercept, etc.), chronic steroids (equivalent or more than prednisone 15 mg per day for 1 month), or other immunosuppressive medication.

Do you have a current or planned immunosuppression?

Yes

Have you had close contact with someone who was diagnosed with infectious Tuberculosis (TB) in the past 12 months?

Yes

Within the last three months, have you had any of the following?:

prolonged, productive cough (3 weeks or longer)
unexplained fever/chills
unexplained chest pain
unexplained night sweats
unexplained fatigue or weakness
unexplained weight loss
loss of appetite

Yes

Have you ever received a BCG (Bacillus Calmette-Guérin) vaccine?

Yes

Medical Release Consent

This Medical Release must be signed by each observer over the age of 18. Observers over the age of 18 must type their full name below and agree to the following statement: I hereby give my consent, in the event of injury or illness, for emergency medical/dental treatment, hospitalization or other treatment as may be necessary for my welfare by a physician, dentist, licensed nurse and/or other hospital employee during all periods of time in which I am participating in an Observation Experience at Logan Health. Further, I hereby waive any liability on the part of Logan Health, its directors, agents and employees, arising out of such medical treatment. I also agree to any charges that may be incurred for such treatments.

Medical Release - Enter your legal name

Please enter your legal name

Signature: The information contained on this form is correct and complete to the best of my knowledge. Type your name in the box below to certify your agreement to all of the above.

If you are under the age of 18, please provide your parent/guardian email.

Application Items:

Observer Badge Photo

Required
Guidelines

Take a headshot where your head takes up 60% of the frame.
Avoid selfies.
Avoid extreme angles and use of filters.
Select a simple background.

Minor Observer Agreement (If you are under the age of 18)

Required if you are a minor.
https://www.logan.org/careers/grow-here/students/career-exploration/
You must be at least 16 years of age to observe in our facilities.
If you are under the age of 18 you will need to have your legal parent or guardian complete the Minor Observer Agreement and upload it to your application.

MMR (measles, mumps, rubella):

*Provide one of the following:

2 official records receiving vaccinations
Positive titer results for each measles, mumps and rubella proving immunity

Varicella (chickenpox):

*Provide one of the following:

Record of 2 vaccinations
Positive titer results proving immunity

Diphtheria, Tetanus, and Pertussis (DTaP, Tdap):

Provide one of the following:

Under 18 years of age:
*Provide one of the following:
4 doses of DTap(one dose must be given on or after 4th birthday)
1 dose of Tdap
18 years of age or older:
One dose of Tdap (Tdap only – does not include DTaP or Td or tetanus)

****You are not required to provide proof of vaccination but if you do not do so, we will consider you to be unvaccinated.

File Upload Area:

Observer Badge Photo
Minor Observer Agreement
MMR (measles, mumps, rubella)
Varicella (chickenpox)
Diphtheria, Tetanus, and Pertussis (DTaP, Tdap)

To ensure a smooth process and prevent delays, please complete your application accurately and upload requested items.

PDF, JPG, or HEIF format only. HEIC is not accepted.

Drop your files here

Are you currently a high school student?

Yes

If you are a high school student, what is the name of your high school?

Type NA if not applicable.

Why are you interested in the observer experience(s)?

Please provide a brief biography that explains who you are and why you are interested in observing this area. This will help us understand your current path, your motivation for observation, and where you are in your academic journey.

What level of study are you planning to pursue?

Are you planning to attend school? Are you currently enrolled in a program and seeking hours for your application?

Thank you for your application. How did you hear about the observer program?

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Career ExplorationStudent Observer Application

Immunosuppression

Medical Release Consent

Application Items:

Career Exploration
Student Observer Application