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Memorial Hospital Accepts All Major Insurances and Payers
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Students


General Information

Memorial Hospital offers placement for students who are enrolled in academic healthcare and nursing education programs. Individuals who are not yet enrolled in a formal academic program may also participate in our job shadow program. Below, you will find instructions and guidelines for students at Memorial. Thank you for your interest!

Please Note:

Registration for both of the programs outlined here should be received at least two weeks in advance of the requested start date.

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Student Parking

All students will receive a yellow parking placard which must be displayed from their automobile rear-view mirror while at the Hospital.  Please make note of the following designated areas for student parking:


Job Shadowing (observation-only) information - Click Here

Job shadowing at Memorial allows an individual to observe first-hand what an occupation in the healthcare field is like. A job shadow participant has the opportunity to get a taste of the workplace environment while gaining a better understanding of the range of duties involved in a healthcare vocation. It also allows the participant to gain a broader awareness of the academic, technical, and personal skills required in a particular profession.

Student Registration (clinical and non-clinical)

All students enrolled in an academic program who wish to complete a rotation at Memorial Hospital must submit the Registration Form below.  Please save the form to your computer hard drive or thumb drive, complete the form, then send it as an attachment to studentaccess@mhg.com.

Registration Form

Once you have submitted a completed registration form you will receive an e-mail from Memorial’s Student Coordinator on how to proceed.  In the meantime, please begin to gather the following documentation that is required as part of the registration process:

The following forms are required as part of the registration process:
  • Immunization records (from your personal health record, doctor’s office, or local Health Department)
  • Results of TB testing completed in the last 12 months
  • Course objectives
  • Current CPR cards (clinical students) – both sides
  • Current background check clearance letter or notarized affidavit (form below) - The letter can be issued by another healthcare facility in Mississippi. If you do not have this letter, you may use the affidavit below and have it notarized. If you use the affidavit, you will need to provide Memorial with the original notarized form. We cannot accept a photocopy, digital copy, or faxed copy of this form.
  • Healthcare Criminal History Affidavit
  • Documentation of Influenza Vaccination or Declination Form (see below) - Individuals that decline or are unable to take the influenza vaccination will be required to submit a declination form and to wear a protective mask anytime they are within 6 feet of a patient care area, including hospital elevators during flu season – October 1st through March 31st.
  • If you’ve been out of the country in the last two months, please also submit the Healthcare Worker Travel Screening Form.

Questions can be answered by emailing studentaccess@mhg.com.


Job Shadow Program (Observation-Only)

A job shadow participant has the opportunity to experience the workplace environment to gain a better understanding of the range of duties and skills required for a healthcare vocation.  Job shadow participants must be at least 18 years of age. This program is observational - it is not a hands-on work experience.

Job Shadow Registration

To register for the program, please submit the Registration Form below. Save the form to your computer hard drive or thumb drive, complete the form, then send it as an attachment to studentaccess@mhg.com.

Job Shadow Registration Form 

Once you submit your registration form, you will be contacted by Memorial’s Student Coordinator for instructions on how to proceed.  In the meantime, please begin to gather the following documentation that is required as part of the registration process:

  • Read the Program Guidelines and sign the Agreement.
  • Immunization records (from your personal health record, doctor’s office, or local Health Department)
  • Results of TB testing completed in the last 12 months
  • Notarized Healthcare Criminal History Affidavit
  • Valid photo ID
  • Print and complete the Communicable Disease Screening Form.  NOTE – During your time at Memorial, if you are exposed to any of the diseases listed or should you develop any of the symptoms described on the form, you should call Professional Development at (228) 865-3362 to cancel your observation. Please do not report to the Hospital while you are ill.
  • Documentation of Influenza Vaccination or Declination Form - Individuals who cannot take the influenza vaccination or decline to take the vaccination will be required to submit a declination form and wear a protective mask any time they are within 6 feet of a patient care area, including hospital elevators during flu season – October 1st through March 31st.
  • If you’ve been out of the country in the last two months, please also submit the Healthcare Worker Travel Screening Form.        

Additional Job Shadow Program information and forms:

Frequently Asked Questions

Sample Shadow Questions

Evaluation Form
(To be completed at the end of your shadow experience)

For questions or concerns that this information does not address, please email your questions to studentaccess@mhg.com

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