2024 Student Shadowing Program - UofA Application Form

Congratulations on your acceptance to the University of Alberta, Faculty of Medicine & Dentistry!

The Alberta College of Family Physicians and the Alberta Medical Association’s Sections of Family Medicine and Rural Medicine are honoured to provide incoming medical students with the opportunity to experience family medicine and all it has to offer.

Please answer the following questions as your responses will assist us in determining the best placement for you. Although every effort is made to match you based on your preferences, placements ultimately rely upon the availability and location of our volunteers.

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* 1. Please enter your contact information:

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* 2. During the placement period of August 10 to 25, 2024, what city/town will you be living in?

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* 3. For University of Alberta students, placements will be offered between August 10 to 25, 2024 (up to 2-4 shifts). Please indicate which days and what time you will be available for shadowing.

  AM PM ALL DAY
Saturday, August 10
Sunday, August 11
Monday, August 12
Tuesday, August 13
Wednesday, August 14
Thursday, August 15
Friday, August 16
Saturday, August 17
Sunday, August 18
Monday, August 19
Tuesday, August 20
Wednesday, August 21
Thursday, August 22
Friday, August 23
Saturday, August 24
Sunday, August 25

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* 4. Do you have access to a vehicle/transportation?

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* 5. Please rank where you would prefer to complete your shadowing experience.

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* 6. Please rank the following list of common family medicine practice settings in from your most preferred to your least preferred option.

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* 7. Why are you pursuing a career in medicine?

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* 8. Based on your current understanding of what family physicians do, are you considering family medicine as your specialty of choice?

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* 9. What aspects of the Shadowing Program interest you?

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* 10. Do you have any other thoughts, comments, questions, or concerns at this time?

TERMS AND CONDITIONS

The Alberta College of Family Physicians reserves the right to cancel or postpone a program without notice due to insufficient registration or circumstances beyond its control. It is also the responsibility of the student to review the Shadowing Program Guidelines prior to their placement.

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* 11. As outlined above, do you agree to the terms and conditions of the Shadowing Program?

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* 12. Please attach a copy of your proof of enrolment. As official proof of enrollment may not be in place, the ACFP will accept confirmation of your acceptance (e.g., email or screenshot of your letter of acceptance).

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