Choice Over Chance Career Exploration Event

Event is being held on Tuesday, May 11, 2021 with Thursday, May 13, 2021 as a make-up day if needed.

Student Information
Student Name*
First Last
Student Address*
Street Address Address Line 2 City State ZIP Code
Birthdate*
Student Email*
Student Phone*
Texting*
Grade in School*
High School*
Other High School Name / City / State*
Parent/Guardian Information
Parent/Guardian Name*
First Last
Relation*
Phone*
Email*
Job Shadow Career Choices
Please list 3 careers/jobs that interest you: (If you have a specific business you want to job shadow at or a certain person to job shadow, please list it next to the career choice)
Transportation to and from the job shadow is the student’s responsibility.
Career/Job Interest 1:*
Career/Job Interest 2:*
Career/Job Interest 3:*
Signature of Release
Student Signature*
By signing below, I agree that the above information is accurate and agree to participate in the work-based learning job shadow experience.
Your Name
Your Name
Your Name
Parent/Guardian Signature*
By signing below, I authorize my child to participate in the work-based learning job shadow experience.
Your Name
Your Name
Your Name
Date*
Northwest Iowa Community College programs provide equal opportunity to all persons regardless of sex, race, age, creed, color, national origin, religion, sexual orientation, marital status or disability. Any Questions, contact Allie Mouw (amouw@nwicc.edu) 712-324-5061 ext. 342
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Student Information