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.

Contact Chad Vail, CCSD Work-based Learning Partnership Coordinator - / 843-937-6489
Student First Name: *
Student Last Name: *
School *
What grade are you in currently? *
Student Date of Birth *
Some WBL Experiences have a minimum age of 18 years old.
Student Email Address: *
Student Mobile Phone: *
Parent / Guardian Name: *
Home Phone: *
Parent Mobile Phone: *
Parent Email Address:
Occupation / Career Interest *
What career are you preparing for?
Work-based Learning opportunity of interest *
check all that apply, descriptions of each here:
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?
Special Considerations *
Please list any sports teams or other extra-curricular activities that may impact your availability.
What is your transportation plan? *
How will you get to and from your assigned WBL experience?
What is your home address? *
Ideally, your WBL location will be near your school and/or home.
Name of recommending teacher or guidance counselor? *
Who at your school encouraged you submit this intent form?
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