Schedule a Shadow Visit

Student Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Preferred Name Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Student Gender REQUIRED Please fill out this field.

Citizenship Status REQUIRED Please fill out this field.

Apply for Grade REQUIRED Please fill out this field.

Current School Name REQUIRED Please fill out this field. Please enter valid data.

Current Grade REQUIRED Please fill out this field. Please enter valid data.

Relationship to Student REQUIRED Please fill out this field.

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Preferred Name Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Relationship to Student

First Name Please enter valid data.

Last Name Please enter valid data.

Preferred Name Please enter valid data.

Phone Number Please enter a phone number.

Email Please enter an email address.

Address Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Please list preferred dates for shadow visit. REQUIRED Please fill out this field.

Do you know someone you'd like to shadow? REQUIRED Please fill out this field.

If yes, please provide name and grade (name,grade) Please enter valid data.

Please select your top 3 Academic Interests REQUIRED History Math Science English Religion World Language Art Other Please fill out this field.

Have you seen our ad on Facebook? REQUIRED Please fill out this field. Please enter valid data.

How did you hear about San Joaquin Memorial? REQUIRED Please fill out this field.

Do you have questions about San Joaquin Memorial?