Student Experiences

The future is bright when it comes to health care careers. Though we’re here always first and foremost to serve the needs of people under our care, we’re also dedicated to supporting education in our region, and that begins with students considering health care careers. That’s why we’re excited you’re interested in our Student Experience and Job Shadow program.

To be considered, please fill out the request form below. You must upload your letter of intent along with your immunization record and acknowledgment form (found below). If you are under 18 please be sure to download the Student Experience Request Form below and have a parent or guardian sign it. You may upload that signed consent with the others at the end of the web form below.

There’s a lot to know, so it’s also a good idea to read through the details below the form.

Finally, be sure to review our information sheet regarding your actions while on our campus at Southwest Health. Call our Human Resources staff at 608-342-5043 with any questions.

Downloadable Forms:
Student Experience Form Student Experience Health Requirements Form Student Experience Information & Acknowledgement Form

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Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Enter Email Confirm Email
Phone Numbers*
Home Mobile Other
Preferred Method of Contact*
- Home Phone
- Mobile Phone
- Other Phone
- Email
Date of Birth*
Month
Day
Year
Are you 18 or older?*
- Yes
- No
If under 18 Please download the attached form and return with a parent's signature authorizing your participation in this program.
Program Experience Desired*
- Job Shadowing
- Clinical Experience
- Community Work
- UWP Clinical Site
- Community Service (Judicial)
- Other
Specific Department/Work Site Experience Requested*
Number of Hours Requested*
Requested Start Date of Experience*
MM slash DD slash YYYY
How did you hear about this opportunity at Southwest Health?*
Immunization Records*
Max. file size: 50 MB.
Please refer to the Student Health Requirements form at the top of the page for details.
Letter of Intent*
Max. file size: 50 MB.
In order to ensure the best student experience possible, you must submit a letter of intent explaining why you are interested in a student experience.
Acknowledgment Form*
Max. file size: 50 MB.
This form is found above. Please upload the completed version or bring it with you on your first day.
TB Skin Test Results
Max. file size: 50 MB.
A two-step TB skin test is required and must have been completed within the past year. If a one-step TB skin test was completed within the last year, an additional one-step TB skin test is needed. If a one-step TB skin test was completed within the last 90 days, no further TB skin testing is needed.
Typing your full name, you agree to abide by all requirements as set forth by Southwest Health policies relating to participation in the above program/experience.*

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Student Experiences

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