2014 Spring Shadow Application- OPEN


Application Deadline: March 10, 2014
Participant Information

*Note: Applicants MUST mail in the most recent copy of their report card. A GPA of at least 2.5 is required.
This program is limited to 35 students and is open to 9th, 10th and 11th graders. *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 office # 812/856-5935.

For more information, please contact Kim Morris-Newson kmorrisn@indiana.edu 812-856-6003 IUB
IUB Disability information listed.




Session 1: March 30th - April 1st, 2014

Session 2: April 6th - April 8th, 2014

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 in Spring 2013 Cumulative GPA:


Medical Information
Please list any physical limitations that may challenge or hinder your
participaton in indoor or outdoor activities:
If you are in need of disability services while on campus, please contact
Indiana University Disability Services at (812)855-7578 or iubdss@indiana.edu.


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.