SPRING 2017 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 January 9, 2017 and January 16, 2017: DATE NO LONGER AVAILABLE
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  1. Please choose the date and program that you will attend from the week of January 23, 2017 through January 27, 2017: DATE NO LONGER AVAILABLE
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  1. Please choose the date and program that you will attend from the weeks of January 30, 2017 through February 10, 2017: DATE NO LONGER AVAILABLE
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  1. Please choose the date and program that you will attend from the week of February 13, 2017 through February 17, 2017: DATE NO LONGER AVAILABLE
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  1. Please choose the date and program that you will attend from the week of February 20, 2017 through February 24, 2017: DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
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  1. Please choose the date and program that you will attend from the week of March 13, 2017 through March 17, 2017:DATE NO LONGER AVAILABLE
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  1. Please choose the date and program that you will attend from the week of March 20, 2017 through March 24, 2017: DATE NO LONGER AVAILABLE
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  1. Please choose the date and program that you will attend from the week of March 27, 2017 through March 31, 2017: DATE NO LONGER AVAILABLE
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  1. Please choose the date and program that you will attend from the weeks of April 3, 2017 and May 3, 2017:
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
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    Friday, April 14, 2017 JA Finance Park **ESE STUDENTS** 9:00am-2:00pm
    DATE NO LONGER AVAILABLE
    Friday, May 5, 2017 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.





Junior Achievement of South Florida