Junior Achievement of South Texas

Job Shadow Day Registration Form

Select JA office nearest you*:

Name*:

Company:

Physical Address:

City: ZIP:

Phone*: Fax:

E-Mail:

The following individual will be my company coordinator handling this project.

He or she will coordinate the logistics and organize the Job Shadow event.

Coordinator Name:

Work Phone: E-Mail:

The following date(s) is ideal to host a Job Shadow Day at my company.

Date 1: Date 2: Date 3:

My company will commit to hosting the following number of students who will participate in a Job Shadow Day:

Please send select the student grade level:

Typically, the students arrive at the workplace at 9:30 AM and depart from the workplace at 1:00 PM. If this schedule does not fit your company's needs, please suggest new time:

Arrival Time: Departure Time:

Check all that apply:

	Our company will participate and will provide chaperones, employees, and lunch for the students.
	Our company will participate, but will not provide chaperones, employees, and lunch for the students.
	I need more information, please contact me.