By completing this form, the Ohio Osteopathic Association (OOA) does not guarantee that the interested student or individual will be matched with a DO. However, the OOA will work with its members to identify DOs who are interested in hosting students for shadowing experiences in their health systems and offices. Thank you for your interest. You will hear from the OOA within ten business days.

Question Title

* 1. What is your first name?

Question Title

* 2. What is your last name?

Question Title

* 3. What are your preferred pronouns?

Question Title

* 4. What is your email?

Question Title

* 5. What is your preferred contact number? xxx-yyy-zzzz

Question Title

* 6. Where do you currently live?

Question Title

* 7. Where would you prefer to shadow?

Question Title

* 8. What interests you in pursuing osteopathic medicine?

Question Title

* 9. Have you identified any COMs that interest you?

Question Title

* 10. Are you attending an undergraduate higher institution now?

Question Title

* 11. If yes, which one?

Question Title

* 12. When can you start shadowing?

Question Title

* 13. How many hours per week do you want to shadow?

Question Title

* 14. For how long do you want to shadow (i.e. September to November)

Question Title

* 15. Are there specialties that interest you? There is no guarantee to match with a specialty DO.

Question Title

* 16. How did you hear about OOA?

Question Title

* 17. Is there anything you want OOA to know?

T