FALL 2016 Broward College Education Students - Field Placement Hours at J.A. South Florida

*PLEASE REVIEW THE FOLLOWING INFORMATION*

In order to meet the Field Placement Hours requirement, you must first complete this form and select the dates you are available. By doing so, you are committing to being present on the days that we need volunteers the most.

You are required to arrive on time and remain in the program until the scheduled end time.

We require a notice to cancel or reschedule a visit date at least 24 business hours in advance, or a doctor's note for absences due to illness.

Any absence without notice will result in the cancellation of your remaining dates.

To participate on the dates you have selected, you MUST email a copy of your clearance badge to rklein1@broward.edu prior to your first visit date.

It is also required that you present your clearance badge on each visit date and have it visible at all times. If you fail to do so, you will not be able to participate in the program and must reschedule your visit date.

PLEASE ALLOW **2** BUSINESS DAYS TO RECEIVE A CONFIRMATION VIA EMAIL AFTER YOU SUBMITTED THIS FORM.

If you have additional questions, please email Jayme-Sky Pagan at jayme-sky@jasouthflorida.org. Thank you.



A red asterisk (*) indicates required questions.


  1. Last Name:*


  1. First Name:*


  1. Primary Email: *


  1. Primary Phone Number:*


  1. Please select the campus where your education course is:

    *


  1. Please select the number of education courses you are enrolled in with the corresponding hour requirement:

    *


  1. Please select the class name(s) that you are enrolled in:

    *


  1. Professor's name:*


  1. Please choose the date and program that you will attend from the weeks of September 12, 2016 and the week of September 19, 2016:
    **DATES NO LONGER AVAILABLE**
    **DATES NO LONGER AVAILABLE**
    **DATES NO LONGER AVAILABLE**
    **DATES NO LONGER AVAILABLE**


  1. Please choose the date and program that you will attend from the week of September 26, 2016 through September 30, 2016:
    **DATES NO LONGER AVAILABLE**
    **DATES NO LONGER AVAILABLE**
    **DATES NO LONGER AVAILABLE**
    **DATE NO LONGER AVAILABLE - 9/30/16 JA FP**


  1. Please choose the date and program that you will attend from the week of October 3, 2016 through October 7, 2016:
    Tuesday, October 4, 2016 JA BizTown 8:00am-1:00pm
    **DATE NO LONGER AVAILABLE**
    Wednesday, October 5, 2016 JA BizTown 8:00am-1:00pm
    Wednesday, October 5, 2016 JA BizTown 9:00am-2:00pm
    **NEW DATE ADDED** Wednesday, October 5, 2016 JA Finance Park 9:15am-2:15pm
    Thursday, October 6, 2016 JA BizTown 8:00am-1:00pm
    Thursday, October 6, 2016 JA BizTown 8:15am-1:15pm
    Thursday, October 6, 2016 JA Finance Park 9:15am-2:15pm
    Friday, October 7, 2016 JA BizTown 8:10am-1:10pm
    Friday, October 7, 2016 JA Finance Park 8:10am-1:10pm


  1. Please choose the date and program that you will attend from the week of October 10, 2016 through October 21, 2016:
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    Thursday, October 20, 2016 JA BizTown 8:00am-1:00pm
    Friday, October 21, 2016 JA Finance Park 7:30am-12:30pm


  1. Please choose the date and program that you will attend from the week of October 24, 2016 through October 28, 2016:
    DATE NO LONGER AVAILABLE
    Monday, October 24, 2016 JA Finance Park 8:45am-1:45pm
    DATE NO LONGER AVAILABLE
    Tuesday, October 25, 2016 JA Finance Park 9:30am-2:30pm
    DATE NO LONGER AVAILABLE
    Wednesday, October 26, 2016 JA Finance Park 9:30am-2:30pm


  1. Please choose the date and program that you will attend from the week of October 31, 2016 through November 4, 2016:
    Monday, October 31, 2016 JA Finance Park 9:30am-2:30pm
    Tuesday, November 1, 2016 JA BizTown 8:00am-1:00pm
    Tuesday, November 1, 2016 JA Finance Park 9:30am-2:30pm
    Wednesday, November 2, 2016 JA BizTown 8:00am-1:00pm
    DATE NO LONGER AVAILABLE


  1. Please choose the date and program that you will attend from the weeks of November 7, 2016 and November 14, 2016:
    Monday, November 7, 2016 JA BizTown 8:00am-1:00pm
    Wednesday, November 9, 2016 JA BizTown 8:00am-1:00pm
    Thursday, November 10, 2016 JA BizTown 8:00am-1:00pm
    Monday, November 14, 2016 JA BizTown 8:00am-1:00pm
    Monday, November 14, 2016 JA Finance Park 9:30am-2:30pm
    Tuesday, November 15, 2016 JA BizTown 8:00am-1:00pm
    Tuesday, November 15, 2016 JA Finance Park 9:30am-2:30pm
    Wednesday, November 16, 2016 JA BizTown 8:00am-1:00pm
    Wednesday, November 16, 2016 JA Finance Park 9:30am-2:30pm
    Thursday, November 17, 2016 JA Finance Park 9:00am-2:00pm
    Friday, November 18, 2016 JA BizTown 8:00am-1:00pm
    DATE NO LONGER AVAILABLE


  1. Please choose the date and program that you will attend from the weeks of November 21, 2016 and November 28, 2016:
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    Monday, November 28, 2016 JA BizTown 8:00am-1:00pm
    Monday, November 28, 2016 JA Finance Park 9:45am-2:45pm
    Tuesday, November 29, 2016 JA Finance Park 9:45am-2:45pm
    DATE NO LONGER AVAILABLE
    Wednesday, November 30, 2016 JA Finance Park 9:45am-2:45pm
    Thursday, December 1, 2016 JA BizTown 8:00am-1:00pm


  1. DISCLAIMER (1/2):

    I understand and agree that by selecting the dates above, I have committed my presence and failure to appear without a 24 business hour notice will result in the loss of ALL my scheduled dates and hinder the opportunity to select alternate dates. *
    I agree.
    I disagree.


  1. DISCLAIMER (2/2):

    I understand and agree that in order to participate in dates I have selected I must email a copy of my clearance badge to rklein1@broward.edu prior to my visit, present my clearance badge on the day of my visit and have it visible at all times. Failure to do so will result in the cancellation and rescheduling of my visit date.*
    I agree.
    I disagree.