contact us: Program Visit Request

Counselors: Please complete the form below and hit the submit button. Direct questions to Patricia Doezema or (616) 365-2370.
Name:
Phone Number:
Email Address:
Week Of:

Please enter your high school.  If you are a home school student, please enter Home School.


*Note: Visits Are Not Available On Mondays Or Fridays.


Student Name Date & Day Of Week Select Session Class To Be Visited
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Program Visitors Are Instructed To Report To The Auditorium Upon Their Arrival.

Please Print And Keep A Copy Of This Form For Your Records