Student Observation Application Question Title * 1. Name Last Name First Name Question Title * 2. Organization Information Name of Organization Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country Question Title * 3. Phone and Email Address Daytime Phone Email Address Question Title * 4. How many students are you looking for an observation opportunity for? 1-5 6-10 10+ I am looking for an observation for myself. Question Title * 5. Program Information What is your program? What degree are you pursing? What year are you in your program? Question Title * 6. What health topic(s) are of interest? Mental health Nutrition Physical activity Reproductive health Substance abuse Diabetes prevention Matter of Balance (fall prevention) Oncology Other (please specify) Question Title * 7. Details What days of the week are you available to observe? Times needed? Hours needed? Do you have a specific number of hours you are required to complete? If so, how many? How many different programs/classes do you hope to observe? Are you interested in youth health education, adult health education, or both? Question Title * 8. Have your students, or you as a student, been background checked? If yes, when? Question Title * 9. What made you interested in the Hult Center for Healthy Living as an observation opportunity? Question Title * 10. Anything else we should know? It is important to know that the Hult Center for Healthy Living's mission is to 'empower people to live healthier lives'. Prior to the start of the observation, all students are required to have the following:*Student observation orientation*Expectation document read, understood, and signed*Proof of a fingerprint criminal background check Done