Paid Work-Based Learning

Are you the parent or legal guardian?

What is your First and Last Name?

First NameLast Name

What is your child's first and last name?

First NameLast Name

What is your phone number?

Area CodePhone Number

What is your email address?

example@example.com

Zip Code

Street Address

Street Address Line 2

Postal / Zip Code

How old is your child?

What school does your child attend?

Please select the option that best applies to your child.

Youth must complete the entire program for our organization to remain in compliance with State requirements.

Does your child have any allergies? If so please indicate below

What industry is your child interested in?

Does your child have any medical issues that staff should be aware of? Such as a seizure disorder or asthma? If so, please describe below:

Do you provide consent for Career Focus, Inc., to use images and/or video footage of your child for marketing and promotion purposes such as Flyers, Brochures or social media ?

How did you hear about our program?

We are registered with the Division of Vocational Rehabilitation (VR) and can provide services to VR customers.

Submitting this inquiry does not automatically authorize an individual to participate in this service. You will be contacted by The Florida Division of Vocational Rehabilitation to determine the next steps required for you to attend. Vocational Rehabilitation may request additional records or documents if needed to determine eligibility for participation in Work Base Learning Experience (WBLE)services.