Spring 2018 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 January 9, 2018 through January 12, 2018:
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE 019BT
    DATE NO LONGER AVAILABLE 0110BT
    DATE NO LONGER AVAILABLE 0110FP
    DATE NO LONGER AVAILABLE 0111BT
    DATE NO LONGER AVAILABLE 0111FP
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE 0112FP


  1. Please choose the date(s) and program(s) that you will attend from the week of January 15, 2018 through January 19, 2018:
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE116BT
    DATE NO LONGER AVAILABLE 116FP
    DATE NO LONGER AVAILABLE 117BT
    DATE NO LONGER AVAILABLE 117FP
    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 January 22, 2018 through January 26, 2018:
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE 123BT
    DATE NO LONGER AVAILABLE 123FP
    DATE NO LONGER AVAILABLE 124BT
    DATE NO LONGER AVAILABLE 124FP
    DATE NO LONGER AVAILABLE 125BT
    DATE NO LONGER AVAILABLE 125FP
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE 126FP


  1. Please choose the date(s) and program(s) that you will attend from the week of January 29, 2018 through Friday, February 2, 2018:
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE 129FP
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE130FP
    DATE NO LONGER AVAILABLE 131BT
    DATE NO LONGER AVAILABLE131FP
    DATE NO LONGER AVAILABLE21BT
    DATE NO LONGER AVAILABLE21FP
    DATE NO LONGER AVAILABLE 0202BT
    DATE NO LONGER AVAILABLE22FP


  1. Please choose the date(s) and program(s) that you will attend from the week of February 5, 2018 through February 9, 2018:
    DATE NO LONGER AVAILABLE 25BT
    DATE NO LONGER AVAILABLE 25FP
    DATE NO LONGER AVAILABLE 26BT
    DATE NO LONGER AVAILABLE 26FP
    DATE NO LONGER AVAILABLE 27BT
    DATE NO LONGER AVAILABLE 27FP
    DATE NO LONGER AVAILABLE 28BT
    DATE NO LONGER AVAILABLE 28FP
    DATE NO LONGER AVAILABLE 0209BT
    DATE NO LONGER AVAILABLE 29FP


  1. Please choose the date(s) and program(s) that you will attend from the week of February 12, 2018 through February 16, 2018:
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE 212FP
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE 213FP
    DATE NO LONGER AVAILABLE 214BT
    DATE NO LONGER AVAILABLE 214 FP
    DATE NO LONGER AVAILABLE 215BT
    DATE NO LONGER AVAILABLE 215FP
    DATE NO LONGER AVAILABLE 216BT
    DATE NO LONGER AVAILABLE FP


  1. Please choose the date(s) and program(s) that you will attend from the week of February 19, 2018 through February 23, 2018:
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE 220BT
    DATE NO LONGER AVAILABLE 220 FP
    DATE NO LONGER AVAILABLE 221 BT
    DATE NO LONGER AVAILABLE FP
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE223FP


  1. Please choose the date(s) and program(s) that you will attend from the week of February 26, 2018 through Friday, March 2, 2018:
    DATE NO LONGER AVAILABLE226BT
    DATE NO LONGER AVAILABLE226FP
    DATE NO LONGER AVAILABLE227BT
    DATE NO LONGER AVAILABLE227FP
    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. Please choose the date(s) and program(s) that you will attend from the week of March 5, 2018 through March 9, 2018:
    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 38BT
    DATE NO LONGER AVAILABLE38FP
    DATE NO LONGER AVAILABLE39BT
    DATE NO LONGER AVAILABLE


  1. Please choose the date(s) and program(s) that you will attend from the week of March 12, 2018 through March 16, 2018:
    DATE NO LONGER AVAILABLE312BT
    DATE NO LONGER AVAILABLE312FP
    DATE NO LONGER AVAILABLE313BT
    Tuesday, March 13, 2018 JA Finance Park 9:45am-2:45pm
    DATE NO LONGER AVAILABLE0314BT
    Wednesday, March 14, 2018 JA Finance Park 9:30am-2:30pm
    DATE NO LONGER AVAILABLE
    Thursday, March 15, 2018 JA Finance Park 9:30am-2:30pm
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE 316FP


  1. Please choose the date(s) and program(s) that you will attend from the week of March 19, 2018 through March 23, 2018:
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE 319FP
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE 320FP
    DATE NO LONGER AVAILABLE 321BT
    DATE NO LONGER AVAILABLE 321 FP
    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 March 26, 2018 through March 30, 2018:
    DATE NO LONGER AVAILABLE - BCPSSB
    DATE NO LONGER AVAILABLE - BCPSSB
    DATE NO LONGER AVAILABLE - BCPSSB
    DATE NO LONGER AVAILABLE - BCPSSB
    DATE NO LONGER AVAILABLE - BCPSSB


  1. Please choose the date(s) and program(s) that you will attend from the week of April 2, 2018 through April 6, 2018:
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE 42FP
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE 43FP
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE 44FP
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE 45FP
    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 April 9, 2018 April 16, 2018 and April 23, 2018:
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    *NEW DATE* Wednesday, April 11, 2018 JA Finance Park 9:00am-2:00pm
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    *NEW DATE* Tuesday, April 17, 2018 JA BizTown 9:00am-2:00pm
    DATE NO LONGER AVAILABLE
    *NEW DATE* Thursday, April 19, 2018 JA Finance Park 9:00am-2:00pm
    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 April 26, 2018 through Friday May 4, 2018:
    *NEW DATE* Thursday, April 26, 2018 JA BizTown 8:00am-1:00pm
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    *NEW DATE* Friday, April 27, 2018 JA Finance Park 9:00am-2:00pm
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE 53BT
    Thursday, May 3, 2018 JA Finance Park 9:30am-2:30pm*
    Friday, May 4, 2018 JA BizTown 8:00am-1:00pm
    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