Auburn University Medical Shadowing Program



AED Medical Shadowing Program Application

supervised by Dr. David Hagan, M.D.

hagandoc@

Note: This program is not open to Medical D members, students who have taken the Premedical Preceptorship, anyone below junior status, or those with significant shadowing experience. Preference will be given to AED members.

Complete and email this form to Dr. Hagan. Once accepted into the program, you must complete a volunteer orientation session with Ms. Elaine Thomas and take proof of a negative TB Skin test dated May 15, 2011 or later to her office to receive an EAMC identification badge. Email her at elaine.thomas@ to schedule your orientation session.

Student’s Name:

Classification (FR/SO/JR/SR/GRAD): GPA:

Year Matriculating at Medical School: Cell Phone No.:

List days (M-F) when you have three-hour blocks of time to shadow and the times:

Example: Mondays from 2:00-5:00 p.m.

AED Member (Y/N): How Many Years:

Describe your academic career (grades, activities, honors, scholarships, etc.):

Describe your career goals:

List previous shadowing experiences:

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