Career Opportunities Home Employee Benefits Our Culture Our Community Career Opportunities for Non-Physicians Physician/Provider Practice Opportunities Requesting to be a Student at MA Frequently Asked Questions
Student Rotation Request Form
Please fill out the following information and submit it at least four weeks prior to your desired start date. If you have any questions regarding this rotation, please contact Human Resources at 563-584-4225. Thank you.
Student Information
Name
Home Address
Phone Number
Email Address
School Information
School Attending
School Address
School Phone Number
School Fax
Name of Program Director/Contact Person
Telephone Number Email Address: Fax Number
Telephone Number
Email Address:
Fax Number
Program you are enrolled in (ie Pre-med, ARNP, CMA, etc)
What year of study you are enrolled in:
Year of Graduation:
Have you rotated at Medical Associates before? Yes No
If yes, using what name? (ie: Maiden)
Student Experience Request (Choose one)
Hands On Rotation Requirement
Observation
If you are requesting Observation, is it required? Yes (it is class requirement, prerequisite for masters program, etc. ) No (it is optional or for informational purposes only) NA (I'm requesting Hands On Rotation)
How many hours will be required with Medical Associates?
What is your desired start date?
What is your desired end date?
What Department(s) or Provider(s) are you requesting?
List the days of the week/hours you are available:
How did you hear about Medical Associates?
Why are you choosing Medical Associates?
What are your career goals for the next 2-5 years?
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