Student Experience Request Form

Story County Medical Center is delighted that you have chosen us to be a part of your healthcare education experience.  To ensure that our patients are protected and students are well prepared, we require all students to complete organizational requirements prior to beginning their student experience at Story Medical.  In addition, students must be at least 16 years old by the date of their observation / job shadow.  You will find the steps you need to continue your student journey below: 

1. Complete the Student Experience Request Form below at least two weeks prior to the requested observation date.  Your request will be forwarded to the department(s) you identified as an interest.  A representative from Story Medical will reach out with additional information.  Please note: Student Experience Requests are accepted on department availability to accommodate the request. 
2. Once the Student Experience request has been approved and scheduled, you will be provided an orientation packet and Confidentiality Agreement to review.
3. After reviewing the orientation packet and Confidentiality Agreement, print and sign the Student Experience Attestation Form and Confidentiality Agreement.  If you are under age 18, a parent or guardian will also sign the attestation form.  
4. On the day of your student experience, bring the signed attestation form and signed Confidentiality Agreement with you and turn into Human Resources.
5. Upon receipt of complete paperwork, you will be provided a temporary badge to be worn at all times during your student experience.  You will turn the badge into Human Resources when your experience is complete.

To ensure that our patients are protected and students are well prepared, we require all students to complete organizational requirements prior to beginning their student experience at Story Medical.

Application