Become an authorized shadow site | Interprofessional Education

Application to become an authorized exposure phase bridge transition shadow site

Practice Site Description*
Practice Site Description: Other*
Site/Activity Name:*
Location:*
Days and Hours available to shadow:*
Research Focus or Population(s) Served:*
Interprofessional Team Members in this activity:*
Please describe the activity a student will observe in a few sentences:*
Are you willing for this site to be available for students to set up a shadowing appointment?*
- Yes
- No
If Yes above, please provide a contact person for students to schedule a shadowing appointment:
Name
First Last
Phone
Email
Thank you for hosting an IPE student and serving as an integral component in the Interprofessional Educational experience for our future health and science professionals! Please contact the Office of Interprofessional Education (OIPE) at ipe@uams.edu if you have any questions about this form or about Exposure phase shadowing expectations.