shadow
Questions marked by * are required.

LET'S GET STARTED
1. Today's Date *
2. Days that work best for you to shadow a Providence student *
  • Monday
  • Tuesday
  • Wednesday
  • Thursday
  • Friday

STUDENT INFORMATION:
3. First Name (Student) *
4. Last Name (Student) *
5. Middle Initial (Student)
6. Street Address *
7. City *
8. State *
9. Zip Code *
10. Home Phone (include area code) *
11. Cell Phone (include area code)
12. Expected Year of Entry *
  • 2011/2012
  • 2012-2013
13. Entering Grade *
14. Present School Attending *

PARENT/GUARDIAN INFO:
15. First Name (Parent/Guardian) *
16. Last Name (Parent/Guardian) *
17. Occupation
18. Place of Business
19. Relationship to Student *
20. E-Mail Address *
21. Home Phone (Parent/Guardian) *
22. Cell Phone (Parent/Guardian)

WE WOULD LIKE TO KNOW:
23. Which electives interest you? (Check all that apply) *
  • Band
  • Broadcast Journalism
  • Choir
  • Theatre
  • Dance
  • Foreign Language-Spanish
  • Foreign Language-French
  • Foreign Language-Latin
  • Visual Arts
24. What classes would you like to see? (Check top three choices) *
  • Computers/Technology
  • English
  • History/Government
  • Math
  • Religion
  • Science
25. What sports/activities are you interested in? (Check top two choices) *
  • Basketball
  • Bowling
  • Softball
  • Soccer
  • Swimming
  • Tennis
  • Track/Cross-Country
  • Volleyball
26. Additional information you would like to share: