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Application For Shadowing Experiences
Application For Shadowing Experiences
Full Name
Age
Personal email (not affiliated with an institution)
Phone Number
Town Of Residence
What Is Your Gender?
Male
Female
Another Gender Identity
I Would Prefer Not To Answer
What Is Your Race/Ethnicity?
Black or African-American
White
Indian-Asian
Asian
Native of Hawaii
Amerindian or Native American
Latino/Hispanic
What Is The Highest Level Of Education You Have Completed?
High School
Associate Degree
Undergraduate Student 1st Year
Undergraduate Student 2nd Year
Undergraduate Student 3rd Year
Undergraduate Student 4th Year
Undergraduate Student In 5th Year
Bachelor Degree
Graduate Degree
What Is/Was Your Concentration Of Study?
Biology
Interdisciplinary Sciences
Chemistry
Pre-Medical
Physics
Environmental Science
Mathematics
Computer Science
Nutrition
Business Administration
Social Sciences
Psychology
Animal Sciences
Agriculture
Engineering
Art
Humanities
Political Science
Nursing
What Career Do You Aspire To Pursue?
Doctor in Medicine (MD)
Doctor in Pharmacy (PharmD)
Doctor in Dental Medicine
Doctor in Chiropractic
PhD
MD PhD
Physician Assistant (PA)
Doctor in Veterinary Medicine (DVM)
Nutritionist
Doctor in Podiatry
What Is Your Employment Status?
Full-Time
Part-Time
Unemployed
Incapacitated
Select The Days You Have Available
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Brief Declaration Of Interest (250 WORDS)
Most Recent Class Program (PDF)
Evidence Of Vaccination Or Vaccine Extension For Religious Or Health Reasons (PDF)
ID With Photo (Preferably License) (PDF)
CV (PDF)
I Confirm That I Am Over 18 Years Of Age At The Time Of Filling Out This Application
Yes
No
Have You Previously Applied For CREPS Experiences?
Yes
No
I have read and understand the conditions previously presented and certify that the information provided is true. If accepted to participate I will comply with the foundation’s rules and expectations of my performance. I accept to receive via email further information about relevant opportunities and information that pertains to my professional goals.
