Required Forms to Complete

Please follow the instructions below and return required forms as a complete application package via email to clinicaleducation@northernlighthealth.org.  Please note that it is the responsibility of the applicant to identify the staff person they will be shadowing and arrange for dates and times for the observational experience.

1. Review, print, sign the bottom of the following documents:

 

 2. Print, complete, and send back the following documents: 

 

3. In your application package, include proof of immunizations including influenza vaccination.   Immunizations must include Hepatitis B (3 doses), MMR (2 doses), and varicella (2 doses).  In the absence of a documented series, Documentation of titers may be substituted. 

If you opt to decline the influenza vaccine, a declination must be signed and submitted with the application and a mask worn during the entire experience. Click here to Download Flu Declination Form

 

4. Background Check - Students in extended clinical experiences at Northern Light Eastern  Maine Medical Center must have a background check completed. The background check must be completed by the school, or completed individually, prior to starting the clinical experience. Provide verification that the background check has been completed by emailing clinicaleducation@northernlighthealth.org. PLEASE NOTE: A background check is not required for students doing a job shadow.

Your application will be put on hold if any of the required forms are missing.