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2024 Shadowing Program - Volunteer Physician Application

Thank you for your interest in volunteering with the Student Shadowing Program (Shadowing Program).

The Shadowing Program is a collaborative offering from the Alberta Medical Association's Section of Family Medicine, Section of Rural Medicine, and the Alberta College of Family Physicians. The program provides new medical students from the Universities of Alberta and Calgary with the opportunity to experience the specialty of family medicine and all it has to offer!

Your responses to the following questions will aid us in the matching process.

Question Title

* 1. Please provide the contact information for you and your practice (i.e., where the shadowing placement will take place).

Note: information provided below will be shared with the student you are matched with.

First Name

Last Name

Clinic Name

Clinic Address

City/Town

Email Address

Phone Number

Question Title

* 2. Which of the following best describes your workplace setting? Please select all that apply.

Private Office/ Clinic (excluding walk-in clinics)

Community Clinic/ Community Health Centre

Free-Standing Walk-In Clinic

Community Hospital

Emergency Department

Long Term Care/ Supportive/ Assisted Living

Other (please specify)

Question Title

* 3. Based on your clinic location and availability, which Shadowing placement period are you able to support?

University of Calgary - June 8th to 28th

University of Alberta - August 10th to 25th

2024 Shadowing Program - Volunteer Physician Application

Question Title

* 1. Please provide the contact information for you and your practice (i.e., where the shadowing placement will take place).Note: information provided below will be shared with the student you are matched with.

Question Title

* 2. Which of the following best describes your workplace setting? Please select all that apply.

Question Title

* 3. Based on your clinic location and availability, which Shadowing placement period are you able to support?

* 1. Please provide the contact information for you and your practice (i.e., where the shadowing placement will take place).

Note: information provided below will be shared with the student you are matched with.