• Dear Student, 

    We at the Northeast Kentucky Area Health Education Center are very excited to assist you in your shadowing experiences and on your path to become a health professional.
     
    In order to qualify for job shadowing opportunities with the Northeast AHEC, you will need to complete this Job Shadowing Application and submit a copy of your immunization records (which includes 2 MMR’s, a flu vaccine if shadowing between October 1 through March 31, and two (2) two-step TB skin test results). You must also submit records of complete COVID-19 vaccination.
     
    Applications can be returned via online form, or by fax, email or mail; you may hand deliver it as well. Also, please dress appropriately when visiting the hospital for your orientation and shadowing experience.

    Upon receiving your completed application, I will contact a preceptor to take you as a shadowing student. After confirming with your preceptor, someone from our office will then contact you to set up an orientation meeting. Following completion of orientation, we will verify a start date and time and you will be allowed to begin your shadowing.
     
    Please note, shadowing experiences at St. Claire HealthCare are limited to 40 hours per year. 

    If you have any questions or concerns about shadowing you may contact me any time! We hope you enjoy your time shadowing with the Northeast AHEC and look forward to accommodating you throughout your journey of becoming a health professional.

    Sincerely,
    Lakyn Newcomb
    Health Careers Coordinator 
    Northeast AHEC
    St. Claire HealthCare
    Email: lakyn.newcomb@st-claire.org
    Office phone: 606.783.6787
    Hannah Little
    Health Careers Coordinator
    Northeast AHEC
    St. Claire HealthCare
    Email: hannah.little@st-claire.org
    Office phone: 606.783.6786
    Fax number: 606.784.2767
    Mailing address: 316 W. 2nd St. 
                             Suite 203
                             Morehead, KY 40351
     
  • Thank you for your interest in job-shadowing in the Northeast Kentucky AHEC service region. Please complete this form to the best of your knowledge.

    Please note that this application requires a signature to be complete. Applications are considered incomplete without the signature in the JOB SHADOWING AGREEMENT section. If you are under age 18, a parent/guardian must sign as well.
     
  • I. GENERAL INFORMATION
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  • EDUCATION:
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  • EMERGENCY CONTACT INFORMATION:
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  • II. SHADOWING EXPERIENCE
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  • III. JOB SHADOWING AGREEMENT
  • 1) I have requested and my host institution hereby grants permission to be present in any setting sponsored by the Northeast Kentucky AHEC for observation to enhance my education.

    In return, I, the Job Shadow Participant, agree to adhere to the following rules:
        a) Read any applicable job shadow program policy, and adhere to the policy. I will ask questions if I do not understand the policy;
        b) Will not be allowed direct patient contact;
        c) Will not be allowed access to the patient medical records;
        d) Will not receive academic credit for the experience;,
        e) Present this signed and completed application prior to the job shadowing experience (if a minor, a parent or legal guardian’s signature is mandatory);
        f) Follow good hand-washing techniques;
        g) Adhere to the job shadow dress code;
        h) Wear personal protective equipment if there is a potential of contacting blood or other body fluids;
        i) Wear a name tag identifying myself as a student;
        j) Inform my mentor/host facility staff if at any time I feel nauseous, dizzy or otherwise ill during the shadowing activity;
        k) Arrive promptly and remain flexible to allow for extenuating circumstances such as patient emergencies that might interrupt the schedule; and
        l) Remain at all times where directed and leave the areas when requested to do so by a physician, nurse, or administration.

    2) I understand the patient/resident’s right to confidentiality and agree to respect that right by not disclosing information regarding any patient or regarding the organization/administration.

    3) I recognize that observing in the healthcare setting and any complication thereof may be emotionally distressing. I also recognize the primary responsibility of the physicians and personnel is to the patient; therefore, it may not be possible to provide immediate attention to me should the need arise.

    4) Job shadowing opportunities may be terminated at any time at the discretion of the host facility, the Northeast AHEC or designee.

    5) In consideration of the permission granted, I hereby release the physicians, the organization, and its staff members from any claims or liability, physical injury and/or damage including emotional distress or injury or mental anguish which may be sustained by me or the patient as a result of the presence of myself in any building sponsored by the host facility.

    6) I am age 16 or older.

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  • VI. ADDITIONAL REQUIRED DOCUMENTS
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