OBSERVER REQUEST

We value your interest in Southcentral Foundation's Nuka System of Care.

To secure an observation opportunity with the Nuka Learning program, you must submit the Observation Request form. It is essential that your application is completed at least four weeks before the desired observation date to ensure adequate approval, onboarding, and clearance.

Please note that incomplete applications will be disqualified from the review process.

OBSERVER INFORMATION

First name*

Last name*

Street address*

City*

State/Region*

Email*

Phone number*

Observation start date must be specified*

Month/Day/Year

Is there a specific date this needs to be completed by or anything else we should be aware of?*

Please select one of the following disciplines*

Please list your Program/College & current year of study

Please list your major or program of study

ADDITIONAL INFORMATION

In 500 words or less, please describe why you chose to have your observation experience at Southcentral Foundation and how this opportunity will help you achieve your personal and professional goals*

Are you Alaska Native or American Indian?

Yes

TERMS OF OBSERVATION

• Comply with confidentiality and privacy requirements for customer-owners (SCF’s term for patients) and their families.

• This experience is strictly observational and can only be completed in SCF clinics. Observations involve up to 40 hours per year and will consist of a hands-off approach with customer-owners. Under any circumstance, the observer is not allowed to handle customer-owner care equipment, supplies, or hand instruments. The observer is not allowed to write in customer-owners' charts. Access to any protected health information will be limited and supervised by a mentor.
 
• Observers are not allowed to discuss customer-owners’ care, condition or status while the customer-owner, family and/or visitors are present, or with anyone outside of SCF employees who are working with that customer-owner. Any breach of this may constitute a HIPAA privacy violation.
 
• Each customer-owner must grant permission for the observer to be there. This permission must be obtained without the observer’s present.

• Customer-Owners or family members may terminate the observation at any time.

• The observer will not receive any monetary or in-kind compensation from SCF for this experience.

• SCF reserves the right to end the experience at any time and for any reason and there is no guarantee of employment at the end of the observation.

• Observers must be accompanied by the mentor at all times in customer-owner care areas.

• Observers must be 18 years of age.

• The observer must agree to maintain a personal accident insurance policy that will provide financial coverage to the student for expenses incurred from an injury while completing a rotation. Students are not considered SCF employees and are not provided with coverage under SCF’s workers’ compensation insurance policy. Proof of the personal accident insurance policy is required.

• The observer is required to comply with all job-related employee health screenings and immunizations before your first day of clinical rotation. Adhering to SCF's Employee Health procedure is mandatory for participation in your clinical rotation. The COVID-19 vaccine is a non-negotiable requirement for all SCF employees and learners.

By clicking the checkbox, I agree to abide by the guidelines listed above while participating in this strictly observational experience at Southcentral Foundation*

For questions regarding application submissions, contact SCF’s Nuka Learning Program:
SCFNukaStudent@SouthcentralFoundation.com
(907) 729-6850 phone
4085 Tudor Centre Drive
Anchorage, Alaska 99508