2025-26 Career Explorations Application Form

CAREER EXPLORATIONS APPLICATION

This form has both student and parent sections that need to be fully completed before final submission. Students may hit the "Save" button at anytime to have an email link sent to them that they can use to complete the student section and/or have parents complete their section. Note: You do not have to create a Jotform Account to save and continue. Simply choose to skip creating an account and it will direct you to input and email address. Application deadline, February 1, 2026. Please only complete one application. If you need to make changes to your applications or have questions, please email us at careerexploration@duneland.k12.in.us.
Date Of Application*

MonthDayYear
Date

STUDENT INFORMATION
Applicant Name*

First NameMiddle Name/sLast Name
Birth Date*

MonthDayYear
Student CHS Email Address*
example@example.com
Student Mobile Number*
Format: (000) 000-0000.
What is your current GPA? (Please use Skyward to confirm your most up to date status).*
What is your current Career Pathway? Click on the Career Pathways Image to the left to view descriptions before choosing to compare what courses you have taken:*
How old will you be when you begin your senior year.*
Are you on track to graduate your senior year*
Are you graduating mid-term*
What extracurricular activities do you plan to participate in during your senior year?*
Place "None" here if you will not participate in anything.
How many Career Exploration blocks would you like in your schedule next year? (1-4 blocks per semester)*

TRANSPORTATION

All students are required to provide their own transportation throughout their Career Exploration experience in order to particpate.
Yes
Do you have a valid drivers license?*

STUDENT ACKNOWLEDGEMENT
Students please read, sign, and date the Student Acknowledgment below:

I recognize that acceptance into the Career Exploration Program is a privilege, and I will accept all responsibilities/obligations for this program and take advantage of every opportunity that will improve my skills in both the classroom and on the job. I understand that it is my responsibility to attend meetings organized by the Career Exploration Staff, in addition to checking my school email consistently for updates and information. In addition, I understand that it is my responsibility to uphold any employer dress codes and other rules of conduct. I also understand that I am responsible for all placement related expences such as backrground checks, vaccinations, drug testing, etc. Further, if I am terminated or removed from my employment/internship, I understand that this is grounds for removal from the program, and it will be reflected in my grade.
Student Signature *
Date*

MonthDayYear
Date

CAREER EXPLORATION EXPERIENCE

Please choose one of the options below. Please note that Work Study Students must provided their own employment placement and maintain their employment throughout the experience. We do not find students Work Study Job placements. Internship placement opportunities, however, are provided by our Career Explorations Team based on the information provided in this application.
Internship (2.5 minimum GPA required)Work Study (2.0 minimum GPA Required)

INTERNSHIP PROGRAM

Please choose your first Career Placement choice and 2nd choice below.
1st Career Placement Choice*
2nd Career Placement Choice*
This ends the student portion of the application. If your parents are not present to complete the next section, please hit the "Save" button and share the link that will be emailed to you with them so they may complete their portion of the application.

WORK-STUDY PROGRAM
Yes, I understand this requirement.
Student Signature*
Date*

MonthDayYear
Date
YesNo

EMPLOYMENT INFORMATION

WORK-STUDY
What is the business name of your employer?
Name of business place here
What is your supervisor's name?

First NameLast Name
What is the phone number of your supervisor?
Please enter a valid phone number.Format: (000) 000-0000.
If avaialble, what is the email of your supervisor?
example@example.com
This ends the student portion of the application. If your parents are not present to complete the next section, please hit the "Save" button and share the link that will be emailed to you with them so they may complete their portion of the application.

PARENT AND GUARDIAN CONSENT TO PARTICIPATE IN THE CAREER EXPLORATION PROGRAM

This section is only to be completed by the student's parent and/or guardian.
Your son/daughter has applied to the Career Exploration Program offered through Chesterton High School. This document gives permission for your child to participate in the program, realizing that each student must provide his/her own transportation to and from the work site, and that your son/daughter must meet the application requirements to be accepted into the program. I also understand that I am responsible for all placement related expences such as backrground checks, vaccinations, drug testing, etc.
First Name* Last Name* has permission to participate in the Career Exploration Program.
Please place Initials here acknowledging consent to the statement above.*
PERMISSION TO TRAVEL
As the parent/legal guardian of the above-named student, I hereby consent that he/she may drive a private vehicle to and from the work site. I acknowledge that he/she is licensed to drive under the laws of the State of Indiana and agree to advise the school immediately if his/her driving privileges are suspended, revoked, or have expired without a timely renewal. I understand that automobile insurance is required.
Please place Initials here acknowledging consent to the statement above.*
As the parent/legal guardian of the above named student, I hereby consent to allow him/her to ride with another student, if necessary, to the work site.
Please place Initials here acknowledging consent to the statement above.*
PHOTO RELEASE
I grant permission for my son/daughter to be photographed or videotaped for promotional and educational purposes while participating in this program.
Please place Initials here acknowledging consent to the statement above.*
Signature*
Date*

MonthDayYear
Date

MEDICAL AUTHORIZATION
Should it be necessary for my son/daughter to have medical treatment while participating in this program, I hereby give the school corporation and/or the work site personnel permission to use their best judgment in obtaining medical services for my child, and I give permission to the physician selected to render whatever medical treatment he/she deems necessary and appropriate.
Please place Initials here acknowledging consent to the statement above.*
Permission is also granted to release emergency contact/medical history to the attending physician or to the work site personnel, if needed.
Please place Initials here acknowledging consent to the statement above.*

INSURANCE INFORMATION
Health Insurance Company*
Name of Policy Holder*

First NameLast Name
Identification Number*
Policy Number*
Name of Parent / Guardian*

First NameLast Name
Parent Work Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Parent Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Parent / Guardian Email*
example@example.com
Family Doctor Name*
Doctor Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
YesNo

If you answered "yes", please explain.

RELEASE OF LIABILITY
I hereby agree to waive and release any and all rights that I, my child, or our representatives may have to make claim against the Duneland School Corporation and my child’s work site or their respective officers,employees, or representatives arising from injury or damages, including attorney fees that may result from my child’s participation in the Career Exploration Program. I further agree to indenify and hold harmless the Duneland School Corporation, its employees, and my child’s work site or their respective officers, employees, or representatives from any claims, including attorney fees, which I or my child might make or which might be made on my or our behalf by others, or which might be made against me or my child by others, arising from my child’s participation in the Career Exploration Experience Program.
Signature*
Date*

MonthDayYear
Date
Should be Empty:

CAREER EXPLORATIONS APPLICATION

STUDENT INFORMATION

TRANSPORTATION

STUDENT ACKNOWLEDGEMENT

CAREER EXPLORATION EXPERIENCE

INTERNSHIP PROGRAM

WORK-STUDY PROGRAM

EMPLOYMENT INFORMATION

PARENT AND GUARDIAN CONSENT TO PARTICIPATE IN THE CAREER EXPLORATION PROGRAM

PERMISSION TO TRAVEL

PHOTO RELEASE

MEDICAL AUTHORIZATION

INSURANCE INFORMATION

RELEASE OF LIABILITY