Required Forms to Complete

Please review each of these important documents


Each experience has a few requirements that must be completed as part of your application process. 

  1. Application for Observation - Please complete this two page PDF document and return as part of your application package.
  2. Confidentiality StatementPlease complete this two page PDF document and return as part of your application package.
  3. Life Safety FormPlease complete this one page PDF document and return as part of your application package.
  4. Student Badge Request FormPlease complete this one page PDF document and return as part of your application package.
  5. Provide proof of your Immunizations - If you are not currently employed in a healthcare facility or currently enrolled in a healthcare college program we must have immunizations.
  6. Provide proof of an Influenza Vaccination - If you do not want the vaccination you must sign a declination form prior to being approved for a shadow. Please contact us for the form.
  7. 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 or fax to 207-973-5237. 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.