PMOE Student Application - Sherman College of Chiropractic

BUSI 810 Practice Management Observation Elective Student Application

You must submit this form by the end of week two of the quarter you are enrolled in Clinic 750 Clinic IV. If you are approved, you will still need to register for BUSI-810 Practice Management Observation Elective during registration week.

FINAL APPROVAL WILL NOT BE GIVEN UNTIL YOU FORMALLY CHECK OUT OF CLINIC

Please note: This is not a clinical externship but a business observational elective. Students are not permitted to participate in any aspect of clinical care to patients.

Students may participate with approved host doctors only. It is recommended that host doctors have a minimum of three years working in practice, be open at least 30 hours per week, and retain at least 400 patient visits per month. Any site not meeting these minimum standards will be evaluated on a case-by-case basis.
The coordinator for academic affairs maintains the list of approved host doctors. The instructor will confirm the assignment with the host doctor when the student’s application process is complete.

All students must make arrangements to meet with the Director of Financial Aid.

Foreign Travel

Opportunities occasionally arise for senior students to participate in the Practice Management Observation Elective in countries outside the United States. These cases will be approved on a case by case basis considering several factors that might impact the student experience. The country must be listed on the State Department “safe to travel” directory to assure the student’s safety. Travel arrangements are completely the responsibility of the student, and the college assumes no responsibility for delays, cancellations or interruptions. Housing and in-country travel are completely the responsibility of the student, and the college assumes no responsibility for problems with housing or transport by common carrier or private means. Participating students are required to sign a statement holding the college blameless for unforeseen events and exempting the college from injury or damage claims that may arise out of the PMOE program.

Name(Required)

Quarter you wish to participate (ex. Fall 2022)(Required)

Your Cumulative GPA(from last grade report)(Required)

Email(Required)

Student Information

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Certification, Please type your initials after each statement to acknowledge your agreement to each.

I understand that I must successfully complete clinic levels 642, 718, 722, 730, 740 and 750 on the first attempt with passing grades for each course to be eligible to participate in BUSI 810 Practice Management Observation Elective.(Required)

I understand I must have no code of conduct violations received at any point in my enrollment in the chiropractic program to participate in PMOE.(Required)

I affirm I am not under any active remediation for clinical competencies or skills.(Required)

I understand that a host doctor must submit an application and be approved for me to participate in PMOE.(Required)

I understand that this is not a clinical externship but a business observational elective. I will not participate in any aspect of a patient’s clinical care.(Required)

I understand that I am prohibited from entering a contractual arrangement with my host doctor prior to graduation.(Required)

I understand that I will not seek compensation nor charge a fee for any of my activities while participating in this program.(Required)

I understand that travel and housing related arrangements are my full responsibility for the duration of time I am participate in PMOE.(Required)

I understand I must formally checkout of the clinic to be eligible to participate in PMOE(Required)

Host DC Choice(s)

Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Have you Contacted these Chiropractors?(Required)

Yes

Has He/She agreed to allow you to observe in his/her office(Required)

Yes

What influenced you to observe this chiropractor?(Required)

Is the doctor an approved host doctor for Sherman College?(Required)

Yes

Please provide your contact information, other than the doctor's office, for the duration of this elective

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Cell Phone #(Required)

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BUSI 810 Practice Management Observation Elective Student Application

Student Information

Certification, Please type your initials after each statement to acknowledge your agreement to each.

Host DC Choice(s)

Please provide your contact information, other than the doctor's office, for the duration of this elective

Important Dates at Sherman

1May

Lyceum 2025

6May

Spring 2025 Midterm Exams

26May

Memorial Day Holiday

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