CCSD Student Interest in Job Shadowing Connection
Thank you for completing the following form to express your interest in a Work-based Learning (WBL) Assignment, like Job Shadowing or an Externship.

The information shared will be used to connect you with an opportunity that aligns with your career interest.

BEFORE SUBMITTING THIS FORM, Please ensure you have spoken with your teacher and your parents about this opportunity.

Questions?
Contact Chad Vail, CCSD Work-based Learning Partnership Coordinator -
chadwick_vail@charleston.k12.sc.us / 843-937-6489

Student First Name:
Your answer
Student Last Name:
Your answer
School
Your answer
What grade are you in currently?
Student Date of Birth
Some WBL Experiences have a minimum age of 18 years old.
MM
/
DD
/
YYYY
Student Email Address:
Your answer
Student Mobile Phone:
Your answer
Parent / Guardian Name:
Your answer
Home Phone:
Your answer
Parent Mobile Phone:
Your answer
Parent Email Address:
Your answer
Occupation / Career Interest
What career are you preparing for?
Your answer
Work-based Learning opportunity of interest
check all that apply, descriptions of each here: http://www.charlestonempowered.com/main/student-wbl/
Required
What would be your ideal connection?
What kind of business do you see yourself being excited to work with? And, is there a specific business you have in mind?
Your answer
Special Considerations
Please list any sports teams or other extra-curricular activities that may impact your availability.
Your answer
What is your transportation plan?
How will you get to and from your assigned WBL experience?
Your answer
What is your home address?
Ideally, your WBL location will be near your school and/or home.
Your answer
Name of recommending teacher or guidance counselor?
Who at your school encouraged you submit this intent form?
Your answer
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