Job Shadow Application

This application is for high school students who are interested in completing a 3.0 hour job shadow work experience with a business or organization in the Greater Burlington area.

Fields marked with an * are required.

First and last name *

Please type your first and last name.

Email Address *

Please type your school email address.

Phone number *

Please include area code, and enter only numeric digits. Example 319-759-2274

Date of Birth *

Example: 11/08/2006

School District Name *

Grade Level *

Gender *

Male

Female

Class requirement *

Is this a requirement for a class? If so, what is the name of the class?

IEP and 504 Plans *

Do you have an IEP or 504 education plan?

Yes

Career Interests *

Please list your top 3 career choices / interests. What careers would you like to shadow? Make sure to list at least 3.

School Interests *

What topics or classes interest you the most at school?

Future Plans *

What are your plans for after school?

Work Experience *

Do you have any volunteer or work experience? If so, please explain.

Job Shadow Application

Please verify that you have checked the “I'm not a robot” checkbox.