Student Participant Roster

JA Job Shadow / AT&T Job Mentoring Event Roster

School District Name of School Teacher Class Period City, State and ZipCode Date of AT&T Site Visit (To be filled out by JA)

Please list students who will be participating in the JA/AT&T Job Mentoring program, including inclassroom lessons and AT&T site visit.
Student Name or ID # 90% of students must meet two of three requirements to participate #1 Low Income Free & Reduced Lunch #2 Absenteeism of greater than 20% #3 Off track with regard to credit accumulation for graduation Please list numbers that apply by student name/ID # 1, 3

Joe Smith (or student number 84-123-4567)

The signature of the school leader below verifies that 90% of the participants in the JA Job Shadow/AT&T Job Mentoring Program experience meet two of the three criteria identified and listed at the top of column B. Printed Name and Title________________________________________________________________ Signature _________________________________________ Date _____________________

JA Job Shadow/AT&T Job Mentoring Program Spring 2013

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