2012 Spring Shadow Application- Closed


Application Deadline: March 8th, 2012
Participant Information

*Note: Applicants MUST mail in the most recent copy of their report card. A GPA of at least 2.5 is required.
*Please mail or fax the letters of recommendation: one from your counselor and one from a teacher. Use the form at the bottom of the application for both letters. Mail before March 3rd to: Eigenmann Hall Room 619, 1900 E 10th St. Bloomington, IN 47406
or Fax: 812-856-0445.




Session 1: April 1-3, 2012
Session 2: April 8-10, 2012

Last Name of applicant: First Name of applicant:
Street address:
City: State: Zip code:
Phone number: Emergency Phone:
No space or hyphen "-" allowed between numbers. Phone number should be entered as follows: 1112223333
Gender: Male Female
Date of Birth (mm/dd/yyyy): E-mail:

General Information

Ethnic Group:
American Indian/Alaskan Native
Asian/Pacific Islander
Latino
Black/African American
White/Caucasian
Other
T-Shirt Size:
Small
Medium
Large
X-Large
XX-Large
XXX-Large

School Name:

Grade level in Spring 2012 Cumulative GPA:

List any awards received, if you do not have any, please fill with "N/A":

Rank the three (1, 2, 3) academic areas you would like to learn more about during Spring Shadow:
First Choice: Second: Third:

Other Academic Areas:

Rank the three (1, 2, 3) extracurricular activities you would like to learn more about during Spring Shadow:
First Choice: Second: Third:

Other Extracurricular Activities:


Medical Information

Please list any physical limitations that may challenge or hinder, if you do not have any, please fill with "N/A"
your participation in indoor or outodoor activities:


Please list any special dietary requirements:

Please List any medical conditions or recent hospital care
(allergies, surgeries, other conditions):



All fields below are required
Parent or Guardian Information

First Name: Last Name:
Home Phone:
Work Phone:
No space or hyphen "-" allowed between numbers. Phone number should be entered as follows: 1112223333
Date:

Click here for the Letter of Recommendation Forms.