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

Date

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* 5. Student Address

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* 7. Student Phone

Country Code
Phone number

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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.

  1. Bloomington (5705 West Old Shakopee Road, Bloomington, MN 55437)
  2. Coon Rapids (9145 Springbrook Drive NW, Coon Rapids, MN 55433)
  3. Eagan (1185 Town Centre Drive, Eagan, MN 55123)
  4. Lakeville (18465 Orchard Trail, Lakeville, MN 55044)
  5. Maple Grove (10150 Niagara Lane North, Maple Grove, MN 55369)
  6. Northeast Minneapolis (3001 Broadway Street NE, Minneapolis, MN 55413)
  7. Plymouth (15700 37th Avenue North, Plymouth, MN 55446)
  8. Vadnais Heights (3588 Arcade St, Vadnais Heights, MN 55127)
  9. Woodbury (237 Radio Drive, Woodbury, MN 55125)