The Morris/Sussex/Warren Workforce Development Board is excited to partner with local businesses to host individuals with disabilities for job shadowing experiences during the month of October. October is National Disability Employment Awareness Month (NDEAM). This form is for disability/vocational service providers to refer individuals with disabilities for this job shadowing experience. Before referring individuals for participation, please ensure they meet the following criteria.
- Have a disability that impacts their ability to obtain and/or maintain employment
- Are at least 18 years old
- Reside in Morris, Sussex, or Warren County
- Are job ready and actively looking for work
- Will be able to participate independently at an employer site without needing ADL or other personal assistance OR will have a direct support professional, employment specialist, or other support individual with them at all times
- Can follow employer directions and safety requirements
- Will have transportation whether self, paratransit, residential staff, family, service provider, etc.
**WE WILL DO OUR BEST TO ACCOMODATE ALL PARTICIPANTS, HOWEVER, WE ARE RELIANT ON EMPLOYER PARTICIPATION. IF WE ARE UNABLE TO MATCH THE PARTICIPANT WITH AN EMPLOYER, WE WILL NOTIFY THE REFERRING ORGANIZATION'S CONTACT PERSON**

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* 1. Participant Name

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* 2. Participant Phone Number

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* 3. Participant Email Address (enter N/A if not applicable)

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* 4. Primary Emergency Contact Information for Participant

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* 5. Secondary Emergency Contact Information for Participant (if Primary cannot be reached)

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* 6. Town Where Participant Resides

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* 7. County Where Participant Resides

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* 8. Referring Organization Name

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* 9. Referring Organization Contact Person

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* 10. Contact Person Phone Number

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* 11. Contact Person Email Address

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* 12. Please describe the participant's job interests including any specific positions (e.g. childcare worker) and general fields of interest (e.g. customer service). This information will be used to match the individual with local employers.

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* 13. Will the participant have a direct support professional, job coach, employment specialist, etc. with them during the job shadowing experience? (If the participant needs assistance with ADLs, ongoing behavioral intervention, medical assistance, etc., a support professional is required for the length of the shadowing experience.)

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* 14. Please describe any accommodations the participant may require in order to participate.

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* 15. Please list any dates the participant would be UNABLE to job shadow during the month of October. 

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