TidalHealth Observership Request

TidalHealth Observership Request

Please use this form to submit a request for an Observership experience at TidalHealth.

**Efforts will be made to accommodate your request, there is no guarantee that your requested observation will be available.

Required Documentation: (documents must be submitted on this form with your request)

Current government issued ID (driver's license, passport, state issued ID)
Student ID
High School students must provide proof of completion of their Freshman Year
COVID Vaccine
Current Flu vaccine (required for observations during the months of October through May.)

International Medical Graduate (IMG) Qualifying Criteria:

First Name*

Last Name*

Physical Address*

Email Address*

Phone Number*

Phone

Associated School/Hospital*

Department of Interest*

(Please include a physician, if applicable.)

Start Date Requested*

End Date Requested

Clinical Needs:*

Please specify the needed time frame of your experience (i.e., single day, number of days, number of weeks, number of hours)

Required Documents*

Please include an attachment of the following required documentation: (your request cannot be processed without this documentation)

Current government issued ID (driver's license, passport, state issued ID)
Student ID
High School students must provide proof of completion of their Freshman Year
COVID Vaccine
Current Flu Vaccine (must provide for observations taking place during the months of October through May)

IMG Documentation Required:

Drag and drop files here or

What racial or ethnic group best describes you?

TidalHealth embraces diversity and inclusion and continues to work toward health equity for everyone on Delmarva.

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