Observation Volunteer Application

Please confirm the date of your observation with your approved medical professional before you submit this application. This application is for shadowing at Henry Ford Hospital - Main Campus (Detroit) and Medical Centers. Shadowing is 7 consecutive days or less and under 40 hours. Please Note it will take us at least 3 business days to respond to your application.

* Asterisk indicates required field.

First Name

Last Name

Address

City

State or Province

Zip Code

E-mail

Phone Number

Are you 15 years or older?

Yes
No

Your current employment status

If Other, please specify

If you are a student provide your current grade level completed and major

Have you or a family member ever worked for Henry Ford Health System or an affiliate, directly or through an agency or as a contractor

Yes
No

If yes, please explain

Volunteer Questions

What date would you need to begin your volunteer role?

mm/yy/dddd

Where would you like to volunteer?

Observation Contact (note you have to supply your own contact, please secure this information prior to applying)

Your contact's name

Your contact's title

What department does your contact work in?

Your contact's phone number

How long will you be shadowing?

If other, please specify

Authentication

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Observation Volunteer Application