Job Shadow ApplicationJob Shadow ApplicationPlease use the form to submit an application for a job shadow opportunity at a host site.First Name*Last Name*What is your current status in ACHE?*Student MemberMemberFellow (FACHE)Address* City ZIP Code Phone*Email* What is your current job title/position?*What organization do you work in?*Level of professional experience?*New Professional (<5years)Mid-Level Professional (5-15 years)Senior-Level Professional (>15 years)Which host site are you interested in?* CentraCare (Redwood) - opportunity to shadow healthcare leadership or pharmacy leadership. Gillette Children's Specialty Healthcare (St. Paul) - opportunity to rotate through several operational areas, as well as the Performance Management and Strategy Office. Life Link III (Twin Cities) - opportunity to shadow healthcare leadership. Mayo Clinic (Rochester) - opportunity to shadow in various departments depending on interests.What amount of time would you like to spend at the host site?* Select All 2 hours 4 hours 6 hoursWould you be open to group job shadowing?*Host site matched with 2-5 shadowers.YesNoUpload Resume*Max. file size: 64 MB.Describe your plans for professional development.*How do you expect the job shadow program will contribute to this plan?Is there anything else you would like us to know?DemographicsCollected for de-identified chapter reporting purposesAge Group*<2525-3435-4445-5455-6465+Gender Identity*FemaleMaleIntersexPrefer not to answerRace*Select all that apply American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White or Caucasian Two or more races Prefer not to answerEthnicity*Hispanic or LatinoNot Hispanic or LatinoPrefer not to answerCAPTCHAΔ
