Standardized Patients Application Form

Please type all responses directly into the boxes. Do not copy/paste text from another source such as Microsoft Word.

Please enter date of birth (MM/DD/YYYY)

Preferred Pronouns

Acting Experience (not required):

Do you have any medical conditions that we should be aware of? If yes, please explain:

Allergies (check all that apply):

Do you have a cat?

Do you have a dog?

Do you have children who may be able and interested in portraying cases?

We have many different roles our Standardized Patient's work in. Please check any areas of interest

Standardized Patients are usually needed Monday through Friday 7:30 AM - 12:00 PM, 12:30 PM - 5:00 PM, or 7:30 AM to 5:00 PM. Please mark ALL your availability:

Are you a MSU student currently attending one of the healthcare colleges? If yes, please select which college you attend:

Are you a student planning to apply to one of the healthcare colleges in the future? If yes, please select which college(s) you may apply to:

To ensure that you receive future communications about job recruitment, please add and to your email address book. Otherwise, our email communications to you may be sent to your email junk mail box.
**Please note that the University requires verification that you are legally authorized to work in the US and will conduct a criminal background check prior to employment