Northwest Job Shadow Application

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Email *

School Name and District *

Last Name of Focus Teacher *

Last name *

First name *

Student Cell Phone # *

Full Address *

Grade Level *

10th (we will be scheduling all 10th for a job shadow during term 2. Transportation provided))

11th (must provide own transportation)

12th (must provide own transportation)

Are you planning to continue your education/training after High School? *

Yes

Will you be 18 before the date of this Job Shadow? *

Yes

FIRST CHOICE

For the following three questions, choose your your top 3 career path choices (choose the career cluster that your career would be in)

SECOND CHOICE

THIRD CHOICE

Is there a particular business or professional person you would like us to contact for your Job Shadow placement? Also, Please list if you have a specific career you would like to shadow (even if you don't have a particular person or business in mind) *

We cannot guarantee placement. We discourage job placements with family members in order to gain new experiences.

Yes

If yes, provide name of career and (if you have it) ALL contact information for employer below. If No, leave blank

Include: Career and (if available) Contact Name - Business Name - Business Phone # - Type of Business

Parent/Guardian Contact Information *

Include: Name - Phone # - Full Address

Emergency Contact information *

Include: Name - Phone # - Full Address

Please have your Permission form signed by your Parent/Guardian and delivered to Randi Watts after job shadow is confirmed.

A copy of your responses will be emailed to the address you provided.

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