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Information Exchange Sheet

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Information About You:

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First Name

Last Name

Address:

Street

City

State

Zip

Contact Information

Phone TypePlease select up to 1 choice

Cell (C)

Home (H)

Please select up to 1 choice

Phone Number

Personal (P) Email Address

School (S) Email Address

Other:

Parent/Guardian Information

Parent/Guardian 1

1 Parent/Guardian Full Name

Only list 1 Parent/Guardian at a time

Best Way to Contact Parents/Guardians 1

Phone

Email

1 Parent/Guardian Phone Number

1 Parent/Guardian Email Address

Parent/Guardian 2

2 Parent/Guardian Full Name

Only list 1 Parent/Guardian at a time

Best Way to Contact Parents/Guardians 2

Phone

Email

2 Parent/Guardian Phone Number

2 Parent/Guardian Email Address

Parent/Guardian 3

3 Parent/Guardian Full Name

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Best Way to Contact Parents/Guardians 3

Phone

Email

3 Parent/Guardian Phone Number

3 Parent/Guardian Email Address

Study Hall Times

Semester 1

Semester 2

Contact Information:

Ginger Sternweis, Pathway Partners Mentoring Program Coordinator

Marshfield High School

1401 E. Becker Rd.

Marshfield, WI 54449

Office: 715-387-8464 x 4559

Cell: 715-650-2255

Sternweisg@marshfieldschools.org

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Information Exchange Sheet

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Parent/Guardian 1

Parent/Guardian 2

Parent/Guardian 3

Study Hall Times

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