Project Rollway 2025 Model Questionnaire

Asterisk (*) indicates required.

Attention: Media Consent

All models must complete a media consent (permission for photos). Click on the media consent link to open in a new tab and complete the form.

If you are under 18 years of age, please have a parent or legal guardian complete the media consent link on your behalf.

First Name

Last Name

Email

What size t-shirt would you like?

What size pants to do you wear?

Please specify if the size above is men's or women's sizing.

How old are you?

What city are you from?

What state are you from?

When were you injured?

How were you injured?

What do you enjoy doing in your free time?

What do you think Shepherd Center was like in 1975

What do you think will change at Shepherd Center in the next 50 years?

What is your favorite Shepherd memory?

What are 1-3 fun facts about you?

Please upload a photo for your model bio.

Please provide 3-5 additional photos of yourself that you'd like to include in the model slideshow. These images can highlight your hobbies, moments with family or friends, participating in therapy, etc.

Photo #1

Photo #2

Photo #3

Photo #4

Photo #5

Contact Information