University Hospital Nursing

Nursing Shadow Day Registration Form

Please provide appropriate information in required fields. Register early for best selection!
Upon completion of form, click submit button at the bottom of the page and your registration will be sent to Cherie Nash, B.S.N., RN, Nursing Recruitment & Retention Office. If you have any questions , please feel free to contact 315-464-6149.

* indicates required fields

Personal Information

*Full Name:

*Address: Street/PO Box number

*City:

*State:

*Zip:

*Home Phone:
(000-000-0000)

Cell Phone:

*Email:

High school or College you attend (if relevant):

Shadow Dates

*Date you would like to attend. Please choose ONE:

November 7, 2007
January 9, 2008
April 8, 2008
May 28, 2008
any of the above dates

Specialty Choice

Nursing offers many different specialties. Please indicate your first and second choices below by placing a number 1 or 2 in the space provided. Space is limited; we will do our best to meet your request.

Ambulatory Surgery & Procedures

Cardiovascular Services (Heart and Blood Vessel Conditions)

Emergency Services

Medicine Services (Kidney & Lung Related Conditions)

Neuroscience Services (Brain & Spinal Cord Conditions)

Orthopedics (Bone Related Conditions)

Pediatric Services (Infant & Child Related Conditions)

Perioperative Services (Before, During and After Surgery)

Health Sciences Library

Self Serve

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