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STUDENT SHADOWING INTEREST FORM
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Required Field
Full Name
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E-Mail
*
Phone Number
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Current school and year
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High School
College – Freshman
College – Sophomore
College – Junior
College – Senior
Other
If "Other" please specify
Name of School or College - If applicable
Area of Interest
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Physical Therapy
Occupational Therapy
Speech Therapy
Reason for wanting to observe at Creighton Pediatric Therapy
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Are you planning to apply to professional school?
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Yes
No
N/A
If Yes, which area?
Physical Therapy
Occupational Therapy
Speech Therapy
Are observation hours required for school application or other experience?
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Yes
No
If Yes, how many hours are required?
What is your availability?
*
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