GVSU Scribe Academy Application

* denotes a required field

Applicant Name & Contact Information

First Name *

Last Name *

Email *

Phone Number *

Primary Address 1 *

Primary Address 2

City *

Zip/Postal *

State *

Country *

Education

University or College of Attendance *

Major *

Minor *

Current Academic Status *

If currently in a program, when do you anticipate graduating?

Are you planning on taking a gap year?

Attached a copy of your Most Recent Unofficial Transcript *
Please upload a file with the extension .doc, .pdf, .rtf, .docx, .jpeg, .jpg, .png, .tiff, or .txt with a maximum size of 3 MB (3072 KB)

Clinical Experience History - Starting with the Most Recent

Have you had current or previous clinical experiences? (shadowing, volunteer or work) *

Describe First Clinical Experience (where, your role, who you worked with)

Describe Second Clinical Experience (where, your role, who you worked with)

Describe Third Clinical Experience (where, your role, who you worked with)

Attach Resume

Resume Upload *
Please upload a file with the extension .doc, .pdf, .rtf, .docx, .gif, .jpeg, .jpg, .png, .tiff, or .txt with a maximum size of 3 MB (3072 KB)

Professional Goals

Where do you see yourself professionally in five years? *

Professional or Academic Reference

First Name *

Last Name *

Title *

Phone

Email

How do you know this reference? *

Optional - Attach Reference Letter(s)
Please upload a file with the extension .doc, .pdf, .rtf, .docx, .jpeg, .jpg, .png, .tiff, or .txt with a maximum size of 3 MB (3072 KB)

Criminal History

Have you ever been convicted of a felony? *

Scribe Training

When do you hope to start training? *
Spring
Summer
Winter

What year can you start training? *

Employment Availability

Please indicate your long-term availability. (18 month year-round minimum) *

Will you have at least three days a week available to be scheduled to work two shifts per week year round? (shifts are approx. 8 hours) *

Which location(s) are you interested in working?
Grand Rapids
Greenville
Big Rapids/Reed City
Zeeland

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