Shadow Day Request

Shadow Date First Choice Date: 

Second Choice Date: 

Student’s Name: 

School: 

Current Grade: 

Home Address: 

City: 

Zip Code: 

Home Phone: 

Student’s E-mail Address: 

Parent’s Name: 

Daytime Phone: 

Parent's E Mail Address: 

Shadow Host request:   
(Hosts must be current IND freshman)

If no host is requested, what academic level would student most likely fall under? 
Honors:     College Prep:    or  Access: