*
Required
Student Last Name
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required
Student First Name
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required
Grade School
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required
(Current school attending)
What grade are you currently in?
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required
Please Select…
6
7
8
Select a Shadow Day
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required
Lunch is provided and (If you are missing school a Permission slip is required.)
Please Select…
Monday, October 13th
Wednesday, November 19th
Tuesday, December 2nd
Tuesday, February 17th
Monday, March 16th
If your previous answer was *other date, provide the date. *Please Note - The Admissions Office will confirm the date requested.
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required
Student Cellphone
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required
Student Email
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required
Home Address
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required
City
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required
State
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required
Zipcode
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required
Parent/Guardian Name
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required
First and Last
Parent/Guardian Phone Number
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required
Parent Email
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required
Did your mother/sister graduate from St. Casimir/Tepeyac?*
Yes
No
If your previous answer is yes, what is her name?
Is there a Student Ambassador that you would like to be paired with?
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required
Are you coming with a friend? If so, please provide her name.
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required
Do you have any questions?
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Please send a confirmation email to the address below*:
Please provide an email address where we can send a link to your current form.
Email Address :