This application must be fully completed prior to being considered for an experience. (Even if you have previously discussed placement with a WRMC employee or provider).
 
Note: Prior to any placement, all requirements must be fully completed and on file at WRMC as requested and directed. Due to our focus on patient care and Making Communities Healthier, WRMC reserves the right to refuse applications.
Information on requirements, can be found at this location http://www.watertownregional.com/work-at-wrmc/student-faqs
 
Before proceeding, determine which type of experience you qualify for and are requesting:
1. College Student Experience  (i.e. clinical, internship, capstone)
2. 1 Day Job Shadow
 

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* 1. First Name

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* 2. Middle Name

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* 3. Last Name

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* 4. Date of Birth

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* 5. Address

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* 6. City

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* 7. State

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* 8. Zipcode

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* 9. Email Address

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* 10. Home/ Mobile Phone

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* 11. Emergency Contact Name, Relationship to you and Phone Number

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* 12. Tell us about yourself: In the field below, please describe yourself and why you are interested in an experience at Watertown Regional Medical Center.

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* 13. Name of School/ College/ University. Please include your Instructors Name  and email address in this box.

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* 14. Grade/ Year in School/ College/ University

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* 15. In the box below, list your
1. Requested Start Date and 
2. If you are applying for an internship or clinical rotation, you must also list the # of hours you are requesting to complete.

Note: WRMC will not approve applications completed and submitted less than 1 month before request start date. We require at least 1 months time to process applications.

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* 16. Please choose one of the following types of experiences:

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* 17. Upon completion of your degree, will you be exploring career opportunities at WRMC?

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