Summer 2019 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 you selected

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 Toni Cichocki , tcichoc1@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.



A red asterisk (*) indicates required questions.

  1. First Name:*


  1. Last Name:*


  1. Primary Email: *


  1. Primary Phone Number:*


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

    *
    North Campus
    Central Campus
    South Campus
    Online Course


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

    *
    1 class = 15 hours = 3 visit dates
    2 classes = 30 hours = 6 visit dates


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

    *
    EDF1005
    EDF2085
    EDF1005 & EDF2085


  1. Professor's name:*


  1. Please choose the date(s) and program(s) that you will attend from the week of May 10, 2019 through May 17, 2019:
    DATE NO LONGER AVAILABLE 5/14/2019
    DATE NO LONGER AVAILABLE 5/13/2019 FP
    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 May 20, 2019 through May 24, 2019:
    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 May 28, 2019 through May 31, 2019:
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE 5/30/2019 BT
    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 June 3, 2019 through June 7, 2019:
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE


  1. DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE
    DATE NO LONGER AVAILABLE





Junior Achievement of South Florida