Heath Career Observation Application

Click, download, complete, and scan the signature page from the forms below before beginning the application:

MSMREF Health Career Observation Program Agreement (required)

Beltway Surgery Center Observation Confidentiality Agreement (only if observing surgery)
*Attach the entire BSC completed form*

  • Date Format: MM slash DD slash YYYY
  • Dates must be 3 weeks after application date. Observation experiences are available for up to two 4 hours blocks to be completed within 1 week.
  • Example: I can't observe Monday-Wednesday before 3pm
    Which MSM location would you like to observe at

  • Preferred Observation Settings

    Select up to 3. We can't guarantee all requests will be available.
  • List at least 3. Only complete and well-thought-out objectives will be considered for application.
  • Can be found at the top of the page. Only scan the signature page, the rest of the pages are clinic information.
  • Can be found at the top of the page. Only scan the signature page, the rest of the pages are surgery center information.