FALL 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 Dr. Kristina M. Taylor, ktaylor3@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 Stephanie Canino at stephanie@jasouthflorida.org. Thank you.

Name: 


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(s) and program(s) that you will attend from the week of October 2, 2017 through October 6, 2017:
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE- 102FP
    DATE NO LONGER AVAILABLE - 103FP
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE - 104FP
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE - 105 FP
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE - 106FP


  1. Please choose the date(s) and program(s) that you will attend from the week of October 9, 2017 through October 13, 2017:
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE - 109FP
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE - 1010FP
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE -
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE - 1012BT
    DATE NO LONGER AVAILABLE - 1012FP
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE - 1013FP


  1. Please choose the date(s) and program(s) that you will attend from the week of October 16, 2017 through October 20, 2017:
    DATE NO LONGER AVAILABLE - 1016BT
    DATE NO LONGER AVAILABLE - 1016FP
    DATE NO LONGER AVAILABLE - 1017BT
    DATE NO LONGER AVAILABLE - 1017FP
    DATE NO LONGER AVAILABLE - 1018BT
    DATE NO LONGER AVAILABLE - 1018FP
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE


  1. Please choose the date(s) and program(s) that you will attend from the week of October 23, 2017 through October 27, 2017:
    DATE NO LONGER AVAILABLE - 1023BT
    DATE NO LONGER AVAILABLE - 1023FP
    DATE NO LONGER AVAILABLE - 1024BT
    DATE NO LONGER AVAILABLE - 1024FP
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE - 1025FP
    DATE NO LONGER AVAILABLE - 1026BT
    DATE NO LONGER AVAILABLE - 1026FP
    DATE NO LONGER AVAILABLE - 1027BT
    DATE NO LONGER AVAILABLE - 1027FP


  1. Please choose the date(s) and program(s) that you will attend from the week of October 30, 2017 through November 3, 2017:
    DATE NO LONGER AVAILABLE - 1030BT
    DATE NO LONGER AVAILABLE - 1030FP
    Tuesday, October 31, 2017 JA BizTown 8:00am-1:00pm
    DATE NO LONGER AVAILABLE - 1031FP
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE 111FP
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE 112FP
    DATE NO LONGER AVAILABLE - 113BT
    DATE NO LONGER AVAILABLE - 113FP


  1. Please choose the date(s) and program(s) that you will attend from the week of November 6, 2017 through November 10, 2017:
    DATE NO LONGER AVAILABLE 116
    DATE NO LONGER AVAILABLE 116
    DATE NO LONGER AVAILABLE 117BT
    DATE NO LONGER AVAILABLE 117 FP
    DATE NO LONGER AVAILABLE 118 BT
    DATE NO LONGER AVAILABLE 118 FP
    DATE NO LONGER AVAILABLE 119 BT
    DATE NO LONGER AVAILABLE 119 FP
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE


  1. Please choose the date(s) and program(s) that you will attend from the weeks of November 13, 2017 and November 20, 2017:
    DATE NO LONGER AVAILABLE 1113 BT
    DATE NO LONGER AVAILABLE 1113 FP
    DATE NO LONGER AVAILABLE BT
    DATE NO LONGER AVAILABLE FP
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE 1115 FP
    DATE NO LONGER AVAILABLE 1116 BT
    DATE NO LONGER AVAILABLE 1116 FP
    DATE NO LONGER AVAILABLE - 1117BT
    DATE NO LONGER AVAILABLE-1117 FP
    DATE NO LONGER AVAILABLE 1120 BT
    DATE NO LONGER AVAILABLE 1120 FP
    DATE NO LONGER AVAILABLE 1121 BT
    DATE NO LONGER AVAILABLE 1121 FP


  1. Please choose the date(s) and program(s) that you will attend from the week of November 27, 2017 through December 1, 2017:
    DATE NO LONGER AVAILABLE 1127BT
    DATE NO LONGER AVAILABLE 1127 FP
    DATE NO LONGER AVAILABLE 1128 BT
    DATE NO LONGER AVAILABLE 1128 FP
    DATE NO LONGER AVAILABLE 1129 BT
    DATE NO LONGER AVAILABLE 1129 FP
    DATE NO LONGER AVAILABLE 1130 BT
    DATE NO LONGER AVAILABLE 1130 FP
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE-121FP


  1. Please choose the date(s) and program(s) that you will attend from the weeks of December 4, 2017 and December 11, 2017:
    DATE NO LONGER AVAILABLE 124BT
    DATE NO LONGER AVAILABLE 124 FP
    DATE NO LONGER AVAILABLE 125 BT
    DATE NO LONGER AVAILABLE 125 FP
    DATE NO LONGER AVAILABLE 126 BT
    DATE NO LONGER AVAILABLE 126 FP
    DATE NO LONGER AVAILABLE 127 BT
    DATE NO LONGER AVAILABLE 127 FP
    NEW DATE Friday, December 8, 2017 JA BizTown 8:00am-1:00pm
    NEW DATE Friday, December 8, 2017 JA Finance Park 9:15am-2:15pm*
    Monday, December 11, 2017 JA BizTown 8:00am-1:00pm
    Monday, December 11, 2017 JA Finance Park 9:30am-2:30pm*
    Tuesday, December 12, 2017 JA BizTown 8:30am-1:30pm
    Tuesday, December 12, 2017 JA Finance Park 9:30am-2:30pm*
    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
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE


  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 Dr. Kristina M. Taylor, ktaylor3@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