The code block below illustrates how one might use # and // as comments in your logic and calculations.

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The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

Hcaw2EvhiBwxevVnqRgKyJe4nA3D7ag9pxhURaeqkcq2GptDwEuPLo8rbM5kADkBIUeILou

The University of Kansas Health System Shadow Program

Returning?

A A A

Please complete the following application survey for the Shadow Program at The University of Kansas Health System.

Applications which include a sponsor will be prioritized. For those applying without a sponsor identified, your application will be placed on hold until you find a sponsor. While we do our best to assist you in locating a sponsor, it is HIGHLY RECOMMENDED that you attempt to identify a sponsor on your own to ensure you will be able to complete your experience in the timeframe requested.

Not sure how to do this? We can help! Email us at kkoenig@kumc.edu.

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Health System Shadowing: Due to the high volume of applications, applicants who are interested in shadowing at the Health System will need to secure a sponsor (professional they will shadow) prior to applying for an experience. Reminder: all shadowing experiences are limited to a single day experience for a maximum of 12 hours. Please contact Kayla Koenig, Shadowing Experiences Coordinator, at kkoenig@kumc.edu with questions or check the Health System website.

Please allow approximately 30 days for processing applications that include a sponsor.

Per health system policy, as of August 7, 2023, the health system no longer requires the COVID vaccine as a condition of employment, shadowing, volunteering.

KEE Research Learner Experiences: Please contact Tereasa Gilmore (tgilmore4@kumc.edu) for additional information or check the KEE website. https://redcap.kumc.edu/surveys/?s=EXPAA4WCXR

Visiting medical students: Eligible for clinical and research experiences ONLY after KUMC medical students have been placed. Research learners (May-July); Clinical learners (June-July) only. Visiting Student Learning Opportunities (VSLO) program for fourth-year electives information can be found at Visiting Medical Students (kumc.edu).

For international visitors, international clinical observers, international research learners, and international clinical elective students (not degree-seeking students nor international employees), are not processed through KEE but processed by the Office of International Programs (OIP), please contact kconnelly@kumc.edu or refer to the program's website.

Please check the Health System and OIP websites and other KU Medical Center sites for updates.

Have you completed the initial Health System Shadow Application form?

* must provide value

Yes

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Date of Application

M-D-Y

Type of educational experience requested?

***OPTIONS***

Hospital Shadow Experience: (observe only in a clinical/hospital setting)

Research Observational Experience: (observe only in a research setting in a KUMC laboratory, research area, or animal facility) https://redcap.kumc.edu/surveys/?s=EXPAA4WCXR

Research Active Learner Experience: (actively participate in a research activity in KUMC laboratories, research areas, or animal facilities for up to four months; also includes active clinical research learners) https://redcap.kumc.edu/surveys/?s=EXPAA4WCXR

Administrative Observational Experience: (observe only in an office/desk setting)

Administrative Active Learner Experience: (actively participate in an office/desk setting)

Other: (please check) (i.e.,Remote Learning Experience Only)

Does your experience not fit into one of these categories? Please select the "Other" radio button and provide further description below. Your proposal will be evaluated for feasibility.

* must provide value

Hospital Shadow Experience

Research Observational Experience

Research Active Learner Experience

Administrative Observational Experience

Administrative Active Experience

Tour participant

Other (please list - i.e., remote only experience)

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If "other", please list

If you are a current KUMC Medical Student, please coordinate directly with your sponsoring department regarding your experience.

I confirm I am currently a KUMC Medical Student

Yes No

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1. First Name

* must provide value

2. Last Name

* must provide value

3. Gender

* must provide value

Cisgender man (Non-transgender)

Cisgender woman (Non-transgender)

Genderqueer

Nongender

Questioning or unsure

Transgender Man

Transgender Woman

Two-spirit

Other

Prefer not to answer

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Zipcode

* must provide value

5. Phone Number (include area code)

* must provide value

6. Email Address

* must provide value

7. I am a (click all that apply):

* must provide value

External (non KUMC) Medical Student

Nursing Student

College/University Graduate Student

College/University Undergraduate Student

High School Student

Working Professional

Other

Where?

* must provide value

Birthdate (M-D-Y):

* must provide value

M-D-Y

Submission Age

View equation

Must be 16 years or older to participate in shadow experiences.

Reason for educational experience request (click all that apply):

* must provide value

Professional development

Career Exploration

School requirement/Academic Credit

Other

Please describe the school requirement:

* must provide value

What are your specific goals or objectives for this educational experience? What do you hope to learn?

* must provide value

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Do you have a sponsor?

Applications which include a sponsor will be prioritized. If you do not have a sponsor, we recommend you continue to search for one. Once a sponsor is identified, you may update your application (PLEASE SAVE YOUR RETURN CODE) and we will continue to process. Please note that finding a sponsor within your time-frame is not guaranteed and it is your responsibility to check with the manager for any updates.

* must provide value

Yes

reset

Sponsor's Department:

Sponsor's email address?

* must provide value

Enter available start date range for your experience:

* must provide value

M-D-Y

Enter available end date range for your experience:

* must provide value

M-D-Y

Please indicate the field or department you would like to experience a shadow opportunity with.

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Would you be interested in a bilingual experience if one is available?

* must provide value

Yes

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If requesting a shadow experience, total hours of observation (shadowing) time requested:

Signature Date:

* must provide value

M-D-Y

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.

The University of Kansas Health System Shadow Program

If you are a current KUMC Medical Student, please coordinate directly with your sponsoring department regarding your experience. I confirm I am currently a KUMC Medical Student

Must be 16 years or older to participate in shadow experiences.

You have selected an option that triggers this survey to end right now.

If you are a current KUMC Medical Student, please coordinate directly with your sponsoring department regarding your experience.

I confirm I am currently a KUMC Medical Student