Shadowing Form

ARKANSAS STATE UNIVERSITY COLLEGE OF NURSING AND HEALTH PROFESSIONS 

 Limited Medical Imaging and Safety Program 

 **Technologists: Please e-mail form to jmcooper@astate.edu You may take a picture or scan this form to e-mail to Jessica Cooper, Special Programs Coordinator. Thank you for supporting A-State Radiology programs and students. 

 Radiology Shadowing Form 

 

 Student Name:                                                                                

 A-State Student ID Number: 

 Facility Name: 

 Shadowing Date: 

 

 

 Student shadowed X-Ray for _____________ hours. Tech shadowed: ______________________________________________ 

 Student shadowed MRI for _____________ hours. Tech shadowed: ________________________________________________ 

 

 

 Staff Signature/Position: 

 Date: 

 Email Address: 

 Phone Number: 

 Additional Comments (student engagement, professionalism, punctuality, etc.):