*
Required
Student Name
*
required
Street Address
*
required
Apartment Number
City
*
required
State
*
required
Zip Code
*
required
(ex. 06108 or 06108-0809)
Current School Attending
*
required
Current Grade Attending
*
required
Please Select…
8
9
10
11
Parish
If applicable
Parent Email
*
required
This will be used to confirm your Shadow Date.
Parent/Guardian Name
*
required
Daytime Phone Number
*
required
First Choice
*
required
(mm/dd/yyyy)
This is not a guarantee. You will be contacted via email one week prior to the confirmed date. Shadow Days run from Monday Through Friday.
Second Choice Date
*
required
(mm/dd/yyyy)
This is not a guarantee. You will be contacted via email one week prior to the confirmed date. Shadow Days run from Monday through Friday.
Do you know any current Roman Students? If so, who?
We cannot guarantee that he will be paired with this student(s).
What are your academic interests?
*
required
What Sports and/or Activities are you interested in?
*
required
Additional Information
How should the student be dismissed?*
Student will be picked up by parent/guardian
Student will go home with a Roman Catholic student
Other
If other, please specify
Please send a confirmation email to the address below: