Preferred Date Pick a Date To schedule an appointment with the Admissions Coordinator, please email admissions@purcellmarian.org or call 513.751.1230. Date Format: MM slash DD slash YYYY Student Information First Name* First Middle Name* Middle Last Name* Last Nickname Suffix Date of Birth* Date Format: MM slash DD slash YYYY Current School* Home Address Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Student Cell Number* Your PM student ambassador will contact you prior to your Shadow Day. Parent Information Parent/Guardian #1 Name* First Last Parent/Guardian #1 Email* Parent/Guardian #1 Preferred Phone Number* Parent/Guardian #2 Name First Last Parent/Guardian #2 Email Parent/Guardian #2 Preferred Phone Number Emergency Information Please provide the following emergency contact information which will be used if a parent / guardian cannot be reached. Emergency Contact's Name* First Last Emergency Contact's Phone* Legacy Information Does the student have a relative (mother, father, sister, brother, aunt, uncle, or cousin) who is a graduate of Purcell Marian High School?* Yes No If yes, please provide name(s) Student Areas of Interest Check all that apply Check all that apply Band Drumline Visual Art Theater/Film Cheerleading Football Baseball Basketball Volleyball Swimming Soccer Track & Field Cross Country Wrestling Service Service Trips Global Experiences International Baccalaureate Career Program Campus Ministry Spanish Latin Sign Language CAPTCHA