Section 1 of 1
Med Science Job Shadow Requests
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Name:
Name:
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Are you a Benefis Employee?
Are you a Benefis Employee?
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Yes
No
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What period do you have your Health Science Class?
What period do you have your Health Science Class?
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1st Period
2nd Period
3rd Period
4th Period
5th Period
6th Period
7th Period
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Who is your teacher?
Who is your teacher?
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Dixon
Lloyd
Marcum
Virts
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What is your age as of right now?
What is your age as of right now?
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Do you participate in a school activity that requires you to miss school occasionally? (speech and debate, swimming, basketball, leadership high, etc)
If you do not have any activies, please type "none".
Do you participate in a school activity that requires you to miss school occasionally? (speech and debate, swimming, basketball, leadership high, etc)
If you do not have any activies, please type "none".
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What is your 1st choice for job shadow placement?
What is your 1st choice for job shadow placement?
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What is your 2nd choice for job shadow placement?
What is your 2nd choice for job shadow placement?
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What is your 3rd choice for job shadow placement?
What is your 3rd choice for job shadow placement?
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Do you have a specific personal connection/name/location for any of your job shadow placements?
Please explain who you know, your relationship, and which placement you have the connection.
Do you have a specific personal connection/name/location for any of your job shadow placements?
Please explain who you know, your relationship, and which placement you have the connection.
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