R-COOL-Health Scrubs Camps – Important Forms and Documents
Forms for Site Coordinators
- Memorandum of Agreement
- Site Coordinator Guide
- Site Coordinator Checklist
- Student Participant Roster Form*
- Student Evaluation Form**
- Scrubs Order Form* | pdf
- Sample Invoice
- Photo/Video & Evaluation Waiver*** | pdf
* This exact form is required for submission to the Center for Rural Health
** Parts A & C required
*** These exact statements must be asked and signed by the parents
Sample Camp Materials
- Agenda
- Confidentiality Agreement Form (Sample) | pdf
- Student Application Form | pdf
Sample Promotional Materials
Materials to Use for Parents/Students/School Administrators
- Health Careers Flyer for Grades 5-12
- Parent Letter (Sample) | pdf
- Job Shadowing Application Form | pdf
- Reasons for Collecting Contact Information | pdf
Forms for Presenters
- Presenter Evaluation | pdf
- Presenter Information Form (Sample) | pdf
- Presenter Q & A
- HIPAA Certification Test
For more information, contact:
Brittany Dryburgh
Project Coordinator
(701) 777-8002