WellSpan Gettysburg Hospital Shadowing Program Application

Areas marked with ! must be completed.

Full Name

Address

Address 2

City

State

Zip Code

Phone

Email Address !

Verify Email Address !

Emergency Contact Name

Emergency Contact Phone

High School Student Only (grades 11 & 12)

Counselor Contact Name

Counselor Phone

Counselor Email Address

Comment on your education / and future health care goals.

What area or specialty are you interested in? !

Please explain your interest

What days and times would you prefer to observe?

Verification Text !

! = Required Field