BEAR for a Day Shadow Request Form

Thank you for your interest in Belzer Middle School. We are the Bruins!

Shadowing Student's First Name*

Please provide the first name of the student wishing to shadow.

Shadowing Student's Last Name*

Please provide the last name of the student wishing to shadow.

Shadowing Student's Preferred Name

Please provide the preferred name of the student wishing to shadow.

Shadowing Student's Gender*

Female

Male

Shadowing Student's Current Grade*

Please provide the current grade level of the student wishing to shadow.

6th

7th

Shadowing Student's Current School*

Please provide the name o9f the school the shadowing student currently attends.

Schedule the Date

Shadowing takes place ...

Best Date to Shadow*

Please select the preferred Wednesday during which the student wishes to shadow.

11/29/23

12/6/23

12/13/23

Second-Best Date to Shadow*

Please select a second date during which the student is available to shadow.

11/29/23

12/6/23

12/13/23

About the Parent/Guardian

Parent/Guardian First Name*

Parent/Guardian Last Name*

Would the parent/guardian like to speak with an administrator or counselor during the shadowing student's visit?*

Yes

No

Parent/Guardian Preferred Phone*

Parent/Guardian Email Address*

Parent/Guardian Street Address

City

State

Zip Code

Areas of Interest for the Shadowing Student

Shadowing Student's First Academic Area of Interest*

Please select from the list below the area of most interest to the shadowing student.

Shadowing Student's Second Academic Area of Interest

Please select from the list below the area of second-most interest to the shadowing student.

Shadowing Student's Third Academic Area of Interest

Please select from the list below the area of third-most interest to the shadowing student.

Shadow Request

Is there a Belzer MS student with whom you are already familiar and that you would like to shadow? Please provide first/last name and grade level of that student. Note: We will try to accommodate your shadow request. However, due to schedule conflicts, sometimes the requested paring is not possible. If this occurs, an appropriate alternate shadow arrangement will be made.

Comments/Questions

Thank You! We will be in touch soon to schedule your visit.

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