Student Job Shadow

Student Job Shadow Form

Shadows/observations are a great way to learn more about careers and specialties in the medical field. Bellin Health offers half day job shadows. This experience is observation only and no direct patient care is allowed.

Which healthcare career(s) are you interested in shadowing? (excluded areas: Surgery, Labor/Delivery, Pediatrics)(Required)

Vaccination History

Required: MMR & Varicella - Acceptable verification: Wisconsin Immunization Registry record, facility record with signature/initials, or titer (blood test) Recommended: COVID-19 & FLU - Vaccination documents or a declination form are required: (Documentation of a Current influenza vaccine for the flu season (Oct 1st - Mar 31st) For declination form, go to https://www.bellincollege.edu/careerconnection and click Vaccination History
Vaccinations (Check Completed Vaccinations)(Required)
Drop files here or
Max. file size: 50 MB.
    You may also send via email to linda.hernandez@bellincollege.edu - For declination form, go to https://www.bellincollege.edu/careerconnection and click Vaccination History

    Greater Green Bay Healthcare Alliance Requirements

    Complete using the Website Link: https://ggbha.org/students/ - VIEW ORIENTATION MODULES 1-4 (HIPAA Privacy & Security, Infection Prevention, Professional Expectations in the Workplace, and Safety in the Workplace)
    Drop files here or
    Max. file size: 50 MB.
      Found on: https://www.bellincollege.edu/careerconnection - You can also email the completed Confidential Agreement Document to Linda Hernandez at linda.hernandez@bellincollege.edu

      Emergency Contact Information

      Career Interest

      Please describe why you are interested in a career within healthcare.
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