FALL 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 Crissy Torres at crissy@jasouthflorida.org. Thank you.

Name: 


A red asterisk (*) indicates required questions.

  1. Last Name:*


  1. First Name:*


  1. Primary School 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 September 17, 2018 through September 21, 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
    DATE NO LONGER AVAILABLE


  1. Please choose the date(s) and program(s) that you will attend from the week of September 24, 2018 through September 28, 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
    DATE NO LONGER AVAILABLE


  1. Please choose the date(s) and program(s) that you will attend from the week of October 1, 2018 through October 5, 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
    DATE NO LONGER AVAILABLE


  1. Please choose the date(s) and program(s) that you will attend from the week of October 8, 2018 through October 12, 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
    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 15, 2018 through October 19, 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


  1. Please choose the date(s) and program(s) that you will attend from the week of October 22, 2018 through October 26, 2018:
    DATE NO LONGER AVAILABLE BT
    DATE NO LONGER AVAILABLE FP
    DATE NO LONGER AVAILABLE BT
    DATE NO LONGER AVAILABLE FP
    DATE NO LONGER AVAILABLE BT
    DATE NO LONGER AVAILABLE FP
    DATE NO LONGER AVAILABLE BT
    DATE NO LONGER AVAILABLE FP
    DATE NO LONGER AVAILABLE BT
    DATE NO LONGER AVAILABLE FP


  1. Please choose the date(s) and program(s) that you will attend from the weeks of October 29, 2018 and November 2, 2018:
    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 November 5, 2018 through November 9, 2018:
    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 weeks of November 12, 2018 through November 16, 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
    DATE NO LONGER AVAILABLE


  1. Please choose the date(s) and program(s) that you will attend from the weeks of November 19, 2018 through November 23, 2018:
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    Tuesday, November 20, 2018 JA BizTown 8:00am-1:00pm
    Tuesday, November 20, 2018 JA Finance Park 9:30am-2:30pm


  1. Please choose the date(s) and program(s) that you will attend from the weeks of November 26, 2018 through November 30, 2018:
    Monday, November 26, 2018 JA BizTown 8:00am-1:00pm
    Monday, November 26, 2018 JA Finance Park 9:30am-2:30pm
    DATE NO LONGER AVAILABLE
    Wednesday, November 28, 2018 JA BizTown 8:00am-1:00pm
    Wednesday, November 28, 2018 JA Finance Park 9:30am-2:30pm
    Thursday, November 29, 2018 JA Finance Park 9:00am-2:00pm*
    Friday, November 30, 2018 JA BizTown 8:00am-1:00pm
    Friday, November 30, 2018 JA Finance Park 9:00am-2:00pm*
    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 December 3, 2018 through December 7, 2018:
    Monday, December 3, 2018 JA Finance Park 9:20am-2:20pm*
    Tuesday, December 4, 2018 JA Finance Park 9:20am-2:20pm*
    Wednesday, December 5, 2018 JA BizTown 8:00am-1:00pm
    Wednesday, December 5, 2018 JA Finance Park 9:20am-2:20pm*
    Thursday, December 6, 2018 JA BizTown 8:00am-1:00pm
    DATE NO LONGER AVAILABLE
    Friday, December 7, 2018 JA BizTown 8:00am-1:00pm
    Friday, December 7, 2018 JA Finance Park 8:00am-1:00pm


  1. Please choose the date(s) and program(s) that you will attend from the weeks of December 10, 2018 through December 14, 2018:
    Monday, December 10, 2018 JA BizTown 8:00am-1:00pm
    Monday, December 10, 2018 JA Finance Park 9:30am-2:30pm
    Tuesday, December 11, 2018 JA BizTown 8:00am-1:00pm
    Tuesday, December 11, 2018 JA Finance Park 9:30am-2:30pm
    Wednesday, December 12, 2018 JA BizTown 7:45am-12:45pm
    Wednesday, December 12, 2018 JA Finance Park 9:30am-2:30pm
    Thursday, December 13, 2018 JA BizTown 8:00am-1:00pm
    Thursday, December 13, 2018 JA Finance Park 9:30am-2:30pm
    Friday, December 14, 2018 JA BizTown 8:00am-1:00pm
    Friday, December 14, 2018 JA Finance Park 9:30am-2:30pm*


  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