Business Name:

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* 1. Business Name:

Industry Represented:
(check all that apply)

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* 2. Industry Represented:
(check all that apply)

Business Partner Contact Name:

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* 3. Business Partner Contact Name:

Address:
(including city and zipcode)

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* 4. Address:
(including city and zipcode)

Business Phone Number:
(including area code)

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* 5. Business Phone Number:
(including area code)

Additional Contact Phone Number:

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* 6. Additional Contact Phone Number:

Email address:

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* 7. Email address:

Business Website:

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* 8. Business Website:

I am a:

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* 9. I am a:

My business and/or employees are willing to:
(check all that apply)

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* 10. My business and/or employees are willing to:
(check all that apply)

What are your goals for working with the Academies of Clay and Clay County's Career and Technical Education students?

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* 11. What are your goals for working with the Academies of Clay and Clay County's Career and Technical Education students?

Do you have a particular school, age group, or geographic area you are interested in working with?
(check all that apply)

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* 12. Do you have a particular school, age group, or geographic area you are interested in working with?
(check all that apply)

Please use the space below to address any questions you have concerning the Academies of Clay or Career and Technical Education:

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* 13. Please use the space below to address any questions you have concerning the Academies of Clay or Career and Technical Education:

As a employer, what do you feel are the most critical skills and abilities students possess upon graduation from high school:

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* 14. As a employer, what do you feel are the most critical skills and abilities students possess upon graduation from high school:

Thank you for your interest in preparing Clay County's students for college and careers. School District representatives will contact you to provide additional information. If you have questions or concerns, please contact the Career and Technical Education Department at 904-284-6574.

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