Modest Scrub Form | Levaris Foundation 1

First & Last Name

Email

Current Occupation and Workplace. (If you are a student, tell us the program you are in and the school.)

Zip Code

Tell us about any issues you've had not being able to dress modestly at work.

Tell us how wearing modest scrubs would change your comfortability at school or work.

What color scrubs do you need for your job or healthcare program as a student? What is your size?

To be selected, you must post our IG flyer online on your Instagram or Facebook. Please note that if it is not posted, you will not be considered. Will you repost our flyer and tag a few sisters in healthcare occupations or school programs?

Yes

No

Please provide an Instagram handle or link. This will be used only to determine if our flyer was posted.

Modest Scrub Giveaway