Senior Shadow Day

Student Personal Information

First Name

Last Name

Preferred First Name

Birthdate

Primary Citizenship

Are you a U.S. Permanent Resident?

Yes

Student Contact Information

Email Address

Confirm Email Address

Mobile Number

Can we text you with information about being a student at GMercyU?

Yes

Would you like to provide a mailing address?

Yes

Mailing Address

Country

Street

City

Region

Postal Code

Student Academic Information

Program of Interest

Enrollment Term

I am a:

First Year Student (high school student/graduate)

Transfer Student (college student/graduate)

Returning GMercyU Student

High School
(If you cannot locate your school in the dropdown, please type the name, city and state of the school.)

Are you a member of Phi Theta Kappa?

Current or Last Attended College/University
(If you cannot locate your school in the dropdown, please type the name, city and state of the school.)

Parent/Guardian Relationship

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

We strive to create an inclusive environment at our events. If there is an accommodation that we can provide to make the event more accessible for you, please type it in the box below.