Section 1 of 3
OP Smile Boteada
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Grade Level
Grade Level
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Date
Time
9th
10th
11th
12th
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Name (Last, First)
Name (Last, First)
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ID Number
ID Number
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School Email
School Email
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Cellphone Number
Cellphone Number
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Emergency Contact Cellphone Number
Emergency Contact Cellphone Number
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REMAINING CSL hours in PowerSchool account
REMAINING CSL hours in PowerSchool account
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Do you have Medical Insurance?
Do you have Medical Insurance?
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Yes
No
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Are you an Operation Smile Club member
Are you an Operation Smile Club member
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Yes
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No
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Section 2 of 3
Operation Smile Club Members
Do you have a preference in shift location?
Do you have a preference in shift location?
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Date
Time
No
Yes; Humberto Lobo
Yes; Gomez Morin
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At what times are you available for your shift?
At what times are you available for your shift?
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Date
Time
Available
Unavailable
Saturday 10 @ 9:00AM—12:00PM
Saturday 10 @ 12:00PM—3:00PM
Saturday 17 @ 9:00AM—12:00PM
Saturday 17 @ 12:00PM—3:00PM
Rows
1.
Saturday 10 @ 9:00AM—12:00PM
2.
Saturday 10 @ 12:00PM—3:00PM
3.
Saturday 17 @ 9:00AM—12:00PM
4.
Saturday 17 @ 12:00PM—3:00PM
5.
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Section 3 of 3
General Application
Do you have a preference in shift location?
Do you have a preference in shift location?
Question Type
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Paragraph
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Date
Time
No
Yes; Humberto Lobo
Yes; Gomez Morin
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At what times are you available for your shift?
At what times are you available for your shift?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
New
Multiple choice grid
Checkbox grid
Date
Time
Available
Unavailable
Saturday 10 @ 9:00AM—12:00PM
Saturday 10 @ 12:00PM—3:00PM
Saturday 17 @ 9:00AM—12:00PM
Saturday 17 @ 12:00PM—3:00PM
Rows
1.
Saturday 10 @ 9:00AM—12:00PM
2.
Saturday 10 @ 12:00PM—3:00PM
3.
Saturday 17 @ 9:00AM—12:00PM
4.
Saturday 17 @ 12:00PM—3:00PM
5.
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Columns
Available
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