Visiting Medical Students: HOW TO APPLY

Please read the instructions thoroughly for each item below, then print, complete and sign all documents.

If Observing at Froedtert Hospital (Clinic and OR) and Community Memorial Hospital:

IF observing at Children’s Hospital:

  • CHW Observer/Job Shadow Agreement Form  (Please see instructions below regarding what portions to complete)
    • Page 5 of 13 Complete the observer request section and all health requirements (see below regarding immunizations). Leave observation dates open, we will fill those in;
    • Page 6 of 13 Please complete “reason for observation”. We will complete the rest.
    • Page 7 of 13 Sign/date in “observer signature” area
    • Page 12 of 13 Please review the Student Orientation Training PowerPoint presentation below. Please check mark everything on page 12 once you have viewed it.
    • Page 13 of 13 Sign/date in “observer signature” area
  • Student Orientation Training
  • Copy of Current Immunization history – All observers in a patient care environment will need to provide immunization/vaccination documentation for the following:
    • tuberculosis **(within the past 12 months)
    • influenza ** (current during flu season; October 1st – April 1st)
    • proof of immunity to Rubella, Rubeola and mumps (documented history of 2 MMR’s or documentation of positive Rubella, Rubeola and Mumps titre
    • Varicella (chicken pox – must have documented history of 2 varicella vaccines or positive varicella titre or documented history from health care provider of chicken pox or shingles – verbal confirmation of the chicken pox will not be accepted).
  • Email, Fax or Mail documents and the dates you are available. (Be sure dates are at least 3 weeks in advance).

∗∗ If you do not have your TB test or influenza, you may call Froedtert Occupational Health at (414) 805-7997, inform them that you are a visitor and there will be no charge.

Services (please rate top 3 choices):

      • Trauma
      • Sports Medicine
      • Oncology
      • Hand & Upper Extremity
      • Foot & Ankle
      • Pediatrics
      • Spine
      • Total Joint Preservation
      • Total Joint Replacement

Please note it may take several weeks to complete your request.


Email, Fax or Mail all required documents to:

Tara Fikejs
Medical Education Coordinator
Dept of Orthopaedic Surgery
Froedtert Specialty Clinics
9200 W. Wisconsin Avenue
Milwaukee, WI 53226-0099

If you have any questions, contact Tara Fikejs at:

Phone: 414-805-7433
Fax: 414-805-7499

tfikejs@mcw.edu