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UW Medicine Primary Care Students & Shadows

Student Agreement Packet

Request a Student Agreement Packet (DocuSign):

For students from UW Programs and students from outside of the UW programs listed:

Please complete the form below. We will be in touch with next steps, including the required form packet. Placement is based on provider availability and not guaranteed.

*It takes at least two weeks to receive approval for your rotation/shadowing session at UWMPC.  Please plan accordingly.

*All students may be required to show proof of vaccinations prior to spending time at a UW Medicine Primary Care Clinic. See link for more information: Employee Health detail page

 

UW Programs List:

UW School of Nursing Programs: DNP—Family Nurse Practitioner | School of Nursing (uw.edu)
Adult-Gerontology Nurse Practitioner
Department of Child, Family and Population Health Nursing

Internal Medicine: Medicine Student Programs | University of Washington (uw.edu)

Family Medicine Clerkship: Family Medicine Student Programs | University of Washington (uw.edu)

MedEx: MEDEX Northwest – Physician Assistant Program (uw.edu)

Primary Care Practicum : Primary Care Practicum

 

 

Request Form

Enter your information below to request a Student Agreement Form. This includes the information required prior to observing in our clinics. Please be aware that applications take time to process. Student and Shadow requests will be processed in the order they are received. Thank you for your interest!

*Note that Student/Shadows are required to show proof of COVID vaccination before entering UW clinic locations.














I have already secured a provider to host me:
What days are you available to shadow or train at the clinic? (check all that apply)
What time of day are you regularly available? (name day of week and times).
I am able to commute to the following clinic(s). [see map below]


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