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Please Download and Read a Copy of this packet for FALCK so that you are aware of the reqruiements for completing your externship.

Failure to abide by the guidelines may result in removal from the externship site and may be considered a violation of the Student Code of Conduct.

By signing and submitting this form, you consent to an electronic signature and acknowledge that your electronic signature is legally binding. You confirm you have read and agree to the waiver terms displayed above.

Required Personal Information

Found in your email. (Example 99999FT-01)
Residence Address
Reason for Ride-Along

Emergency Contact Information

Emergency Contact Name

Ride-Along Request Information

NOTE: THESE DATES MUST MATCH WHAT YOU PUT ON THE EXTERNSHIP REQUEST FORM OR THE DATES WILL BE REJECTED
Preferred Stations
Day or Night Shifts

Verification Section

For Example: Driver's License Number
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Name
Clear Signature

Parent/Guardian Section

Parent or Guardian Signatures are required if the student is under 18 years of age at the time of signing this form.
Clear Signature

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