Henry County Schools Work-Based Learning Program
Total Page：16
File Type：pdf, Size：1020Kb
Henry County Schools Work-Based Learning Program SY 2014-2015 Application Packet Students must be pre-approved by the Work-Based Instructional Leader before placement into the program. Henry County Schools does not discriminate on the basis of race, color, religion, sex, national origin, or disability in its programs, activities, or employment practices. School-Based Program Facilitators Work-Based Instructional Leader Mrs. Karen Robertson [email protected] Dutchtown High School Counselor Mrs. Rebecca Hill 770-515-7510 Work-Based Instructional Leader Mrs. Dwanda Brew [email protected] Eagle’s Landing High School Counselor Mrs. Susann Livingston 770-954-9515 Work-Based Instructional Leader Mr. Chad Drake [email protected] Henry County High School Counselor Dr. Dawn Turner 770-957-3943 Work-Based Instructional Leader Ms. Connie Stewart [email protected] Locust Grove High School Counselor Ms. Joan Prisk 770-898-1452 Work-Based Instructional Leader Ms. Sandra Braswell [email protected] Luella High School Counselor Mrs. Keosha Glover 770-898-9822 Work-Based Instructional Leader Mr. Joey DiNino [email protected] Ola High School Counselor Mr. Rick Marinaccio 770-288-3222 Work-Based Instructional Leader Mrs. Deborah Gilliam [email protected] Stockbridge High School Counselor Ms. Letita Graham 770-474-8747 Work-Based Instructional Leader Mrs. Joy Cox [email protected] Union Grove High School Counselor Dr. Wes Silvey 678-583-8502 Work-Based Instructional Leader Ms. Debbie Hibben [email protected] Woodland High School Counselor Dr. Delicia Fellers 770-389-2784 Christina Hinz, CTAE Supervisor HENRY Henry County Schools 401 E. Tomlinson St. COUNTY McDonough, GA 30253 770-320-7997 Fax: 678-610-5853 SCHOOLS [email protected] {Client: 0000143 Matter: 0000 Doc: 00495447.DOCM} Revised 12-13 HENRY COUNTY SCHOOLS WORK-BASED LEARNING Student Checklist Write your name where indicated on all pages. Complete the Student Information section of the application. Deliver the academic teacher recommendation form. Deliver the CTAE teacher recommendation form. Deliver the Counselor form. Have the Parental Consent Form signed by your parent/guardian. Update your Ga College 411 account Be sure you have signed the pages where indicated. Return all completed application materials to your WBL Instructional Leader before registration. Only completed applications will be considered. -------------------------------------------------------------------------------------- WBL Instructional Leader Checklist Completed application form Parental signature on Parental Consent Form Academic teacher recommendation form Career Tech teacher recommendation form Counselor form Completed CTAE coursework in ______________________ (pathway) Ga College 411 updated account Copy of work permit and attendance letter (if accepted) It is the policy of the Henry County Board of Education not to discriminate on the basis of age, sex, color, religion, national origin, disability, or handicap in its educational programs, activities, or employment practices. {Client: 0000143 Matter: 0000 Doc: 00495447.DOCM} Work-Based Learning Application Packet 2014-2015 Page 2 HENRY COUNTY SCHOOLS WORK-BASED LEARNING Student Information Student Name ______________________________________Preferred Name _____________ First Name Middle Name Last Name Student Number __________ Graduation Year ________ Counselor ___________________ Home Information: (please print legibly) Street Address__________________________________________________________________ City__________________________ Zip_____________ Home Phone____________________ Student Cell Phone:___________________ Student Email ______________________________ Parent Cell Phone_____________________ Parent Email _______________________________ Parent Cell Phone_____________________ Parent Email _______________________________ Date of Birth _______________ Age on August 1, 2013 ______ Career Pathway: Please select the pathway you are currently studying or have completed in high school: Agriculture - Agriscience Engineering Architectural Drawing Engineering Graphics and Design Broadcast Video Production Electronics Business – Accounting Family and Consumer Science – Nutrition & Food Science Business – Computing Government and Public Safety - JROTC Business – Interactive Media Government and Public Safety – Law & Justice Business – Small Business Healthcare Science – Medical Services Development Cosmetology Marketing – Marketing and Management Culinary Arts Early Childhood Education Occupational Goal: _______________________________________________________________ Where do you plan to pursue post-secondary training? __________________________________ It is the policy of the Henry County Board of Education not to discriminate on the basis of age, sex, color, religion, national origin, disability, or handicap in its educational programs, activities, or employment practices. Be sure to complete the other side! {Client: 0000143 Matter: 0000 Doc: 00495447.DOCM} Work-Based Learning Application Packet 2014-2015 Page 3 HENRY COUNTY SCHOOLS WORK-BASED LEARNING Student Information (continued) Employment Information Do you have a Work Permit? □ Yes □ No ~Current employment is NOT a requirement in order to apply for Work-Based Learning~ List all work experience (list current job first): Date From Date To Company Job Title Supervisor List work-related skills you possess that make you a desirable employee: If you are chosen to participate in Work-Based Learning, reliable, consistent transportation to and from the work site is your responsibility. Do you agree to this? □ Yes □ No Describe the vehicle you will be using to participate in the Work-Based Learning program. Make _______________Model ______________________ Tag # __________________ License # ______________Insured by _____________________ Have you had any traffic violations? □ Yes □ No If yes, explain __________________________________________________________________ Who owns this vehicle? If you do not own this vehicle, do you have the permission of the owner to use this vehicle for the Work- Based Learning Program? □ Yes □ No You must maintain your own transportation, insurance, and a valid Drivers License to remain in the program. Please answer all the following questions: 1. Is there any medical reason(s) that you feel would interfere with the performance of your Work-Based Learning duties? □ Yes □ No If yes, what accommodations do you feel would allow you to perform these duties? ____________________________________________________________________________ 2. Do you have any responsibilities or obligations that could interfere with your ability to commit time after normal school hours to the Work-Based Learning Program? (Example: sports, band, school or community activities, part-time job, family/child care responsibilities, or night school) □ Yes □ No If yes, describe _____________________________________________ 3. What Career, Technical, and Agricultural Education knowledge and skills will Work-Based Learning enhance? ______________________________________________________________________________ {Client: 0000143 Matter: 0000 Doc: 00495447.DOCM} Work-Based Learning Application Packet 2014-2015 Page 4 HENRY COUNTY SCHOOLS WORK-BASED LEARNING Program Guidelines As a condition for acceptance into Work-Based Learning (WBL) Programs, and to remain in the program, I agree to the following: 1. I understand that my actions reflect upon my school, the Work-Based Learning Program, and Henry County Schools, and I will conduct myself in a manner that will reflect positively on all of them. 2. I will not go to work on any day that I am absent from school or class unless specifically approved by the WBL Instructional Leader before reporting to work. Working without attending school may negatively affect my grade. 3. I will maintain an excellent attendance/tardy record. I will make up all class assignments I may miss. Completion of schoolwork is a requirement for continued participation in Work-Based Learning; therefore I will maintain passing grades in all classes. 4. I understand that this program is about learning in the workplace, and that I must gain verifiable employment at an approved site prior to the first day of school. 5. I will obtain a current work permit and be responsible for returning the completed permit to the school office prior to the first day of school. 6. I will immediately notify the WBL Instructional Leader if I am fired/released, resign or quit from my job. Failure to notify the WBL Instructional Leader about this situation may result in my being removed from the program and grade loss. 7. I understand that my grade will be lowered for being fired due to poor performance, quitting my job without permission, falsifying reports, or other inappropriate conduct. 8. I will obtain permission from the WBL Instructional Leader before changing employment. 9. I understand that all work sites/job locations must be approved by the WBL Instructional Leader. 10. I will demonstrate a cooperative attitude, abide by all rules set out by the WBL Instructional Leader and set forth in the training agreement, and refrain from any misconduct. Suspension from school may result in my being removed from the Work-Based Learning program. Work-Based Learning students must abide by the school discipline policy, including remaining at school for ISS. 11. I will notify the WBL Instructional Leader of any school or