STUDENT INFORMATION

Please complete this form to participate in the GI Track Shadowing Program. Students must be 16 years or older to participate.

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* 1. Student Name

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* 2. Student Preferred/Chosen Name (optional)

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* 3. Student Pronouns (optional)

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* 4. Student Date of birth

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* 5. Student Address

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* 7. Student Phone

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* 8. What school will the student attend in the Fall of 2025?

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* 9. What grade/year will the student attend in the Fall of 2025?

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* 10. What days is the student usually available? (Select all that apply.)

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* 11. Are there any dates in June - August 2025 when the student will be unavailable to shadow?

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* 12. Below is a list of locations for shadowing experiences. Please rank them in order of preference, with #1 being the most preferred location and #9 being the least preferred location.

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