- Please complete the Intern Information/Student Affiliate Form.
- All student affiliates must be fingerprinted for the Department of Developmental Disabilities (DDD) and the Department of Education (DOE) by Morpho Trust.
- Morpho Trust requires separate appointments for each agency, but you must schedule both of the appointments during one visit.
- All original paperwork, including copies of the two receipts received from MorphoTrust, should be sent to Human Resources prior to your program start date.
- Upon acceptance into the Clinical Affiliation program, all student affiliates must provide a recent (within one year) physical exam performed by a licensed physician, nurse practitioner, or physician assistant indicating freedom from communicable disease and ability to perform the physical demands of the position.
- All student affiliates must provide proof of a TB blood test (IGRA) or 2-step Tuberculin skin test within the past year – Chest X-ray if positive tuberculin responder (must submit past result and x-ray).
- All student affiliates must provide a copy of immunization records which indicate receipt of MMR vaccine (2 doses) in childhood and the completed Hepatitis B vaccine (3 doses) or immune titers.
- All student affiliates must provide proof of a Tdap vaccine – One dose as an adult.
- All student affiliates must provide proof of COVID-19 vaccination – Primary series plus booster.
- All student affiliates must provide proof of proof of varicella vaccination or titer.
- All health information (#5, 6, 7, 8, 9 & 10) should be submitted to Employee Health on the day of your arrival at Matheny or faxed in advance to the confidential fax #: 908-781-6816, addressed to Joan Ray, Employee Health Coordinator.
- Please complete the following forms and email Vanessa Vitez at firstname.lastname@example.org or fax (908-781-6816) prior to your start date: Background Check Authorization
- Prior to the commencement of your clinical affiliation, your University/College must provide Matheny with a Certificate of Insurance.
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