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]

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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.

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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? ______

Be sure to complete the other side!

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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?

______

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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 work related problems that might affect my ability to maintain my employment. 12. I understand that the WBL Instructional Leader is the recognized authority for making adjustments or changes in my release schedule. If appropriate, the WBL Instructional Leader will recommend that my privileges be revoked and require me to remain at school during planned release periods. 13. I understand that my schedule may be affected by school activities or work-based learning meetings/conferences, and I must adhere to the adjusted schedule and make suitable arrangements with my employer. 14. I realize that I am expected to contribute to the countywide end-of-year Employer Appreciation recognition activity.

______Student Signature Date

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Parental Consent Form

It is my understanding that my child,

(Student’s Name) ______would like to be considered to participate in a Work-Based Learning program (Cooperative Education, Internship, Youth Apprenticeship) which may take place both during and outside his/her regular school hours.  I have read the attached information, including the Program Guidelines located on page five (5) of this application packet.  I understand that this experience is a commitment and that my child may have to put this opportunity over other commitments. I understand my child may need this credit in order to graduate.  I understand that my child will be required to provide his/her own transportation (if driving) daily to and from the worksite or other instructional activities which are part of the Work Based Learning program and that he/she must maintain a valid GA driver’s license and provide proof of automobile insurance coverage. If my child does not have his/her own transportation to participate in the activities of the Work-Based Learning program, I agree to provide or obtain the transportation my child needs to participate in the Work-Based Learning program.  I understand that my child must have adequate accident insurance coverage OR enroll in the school insurance plan (24 hour coverage).  My child is drug-free and I hereby consent to any requirement by any employer that my child submit to a drug screening.  I give my permission for my child to pursue participation in Work-Based Learning program.  I understand that the Work-Based Learning Instructional Leader will make the final decision as to whether my child is accepted into the Work Based Learning program for the 2013-2014 school year.

______Parent/Legal Guardian signature Date

(Must be signed and returned with completed application packet for consideration)

For more information, please refer to FAQ’S regarding Work -Based Learning (next page)

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What is Work-Based Learning?

Work-Based Learning Programs are structured educational experiences that integrate classroom learning (school- based) with productive, structured work experiences (work-based), which are related to a student’s career goal and Program of Study.

Work-Based Learning provides an opportunity for juniors and seniors (age 16+) to start preparing for a career while still in high school.

Is this new?

In the past, these types of programs were referred to simply as just “work release” programs. New expectations require that all work-experience programs be an extension of the educational curriculum that is conducted in a real- world [work] setting.

What are the requirements for the program?

Work-Based Learning provides an opportunity for juniors and seniors (age 16+) to start preparing for a career while still in high school. Individual Programs of Study that encompass the student’s career objective better prepare students for successful educational experiences. An approved application is required.

What can students hope to achieve through Work-Based Learning?  Earn wages while learning from skilled professionals,  Increase career options and future employability,  Strengthen academic skills,  Experience the connection between education and real-life work skills, and  Experience potential careers in the workplace. What can employers hope to gain through Work-Based Learning?  Play an active role in shaping the quality of their future workforce,  Increase skill levels of potential workers,  Work with educators to develop curriculum that is based on industry standards and expectations,  “Grow Your Own” workforce, and reduce turnover of employees through the hiring of qualified Work- Based Learning graduates,  Recruit and screen potential employees, and  Improve competitiveness in the international marketplace.

What is the role of the school counselor?

School guidance counselors advise Work-Based Learning students regarding courses needed to complete graduation requirements and/or prepare students for post-secondary plans.

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Student: fill in only Counselor Confidential Referral Form name and ID #

Student’s Name ______Student ID # ______

Is this student on track to graduate? YES NO

Courses necessary to place student back on track:

______

CTAE pathway: ______

Projected 2014-2015 Course Request (Required)

1. ______

2. ______

3. ______4. ______5. ______6. ______7. ______Alt: ______Alt: ______Alt: ______

Please list alternate courses for student in the event that WBL is not an option for this student.

Does this student qualify for an IEP? □ Yes □ No

______Counselor Signature Date

Counselor: Return this form to your school Work-Based Instructional Leader.

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Additional comments by counselor:

{Client: 0000143 Matter: 0000 Doc: 00495447.DOCM} HENRY COUNTY SCHOOLS WORK-BASED LEARNING CONFIDENTIAL CTAE TEACHER RECOMMENDATION FORM ~~~Detach and take to your CTAE teacher~~~ Work-Based Learning programs are an extension of school-based curriculum into the workplace. Through these experiences, students will be exposed to a wide range of general workplace knowledge and competencies, with the goal being to better prepare students for future opportunities. The program is voluntary, and designed for a group of selected students entering their junior/senior year. The student listed below has applied to participate in Work-Based Learning. Please assist us by completing this form and returning it to the school Work-Based Instructional Leader as quickly as possible. Thank you.

Student’s Name ______Student ID # ______

Please check in the appropriate column the factors for which you have adequate information for appraisal. EXCELLENT GOOD FAIR POOR

1. Ability to follow instructions

2. Social skills (gets along well/respect for others)

3. Demonstrates dependability

4. Self-motivated

5. Demonstrates responsibility (directs energies toward tasks)

6. Demonstrates enthusiasm in performing assigned tasks

7. Strives for excellence

8. Punctual

9. Mentally alert (organization skills/problem-solving skills)

10. Demonstrates proper etiquette and manners

11. Personal appearance/grooming

12. Demonstrates integrity/honesty

13. Demonstrates optimism and self-respect

14. Capacity to try new ideas and increase knowledge

15. Attitude toward constructive criticism

16. Ability to adapt to change

17. Cooperates with others

18. Communication skills

19. Demonstrates attention to detail

20. Ability to set realistic goals

Do you recommend this applicant for the Work-Based Learning program? □ Yes □ No Please make additional comments on back.

______Printed Name Teacher Signature Date

Teacher: Please return this form to your school Work-Based Learning Instructional Leader

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Additional comments by CTAE teacher:

{Client: 0000143 Matter: 0000 Doc: 00495447.DOCM} HENRY COUNTY SCHOOLS WORK-BASED LEARNING CONFIDENTIAL ACADEMIC TEACHER RECOMMENDATION FORM ~~~Detach and take to your Academic teacher~~~ Work-Based Learning programs are an extension of school-based curriculum into the workplace. Through these experiences, students will be exposed to a wide range of general workplace knowledge and competencies, with the goal being to better prepare students for future opportunities. The program is voluntary, and designed for a group of selected students entering their junior/senior year. The student listed below has applied to participate in Work-Based Learning. Please assist us by completing this form and returning it to the school Work-Based Instructional Leader as quickly as possible. Thank you.

Student’s Name ______Student ID # ______

Please check in the appropriate column the factors for which you have adequate information for appraisal. EXCELLENT GOOD FAIR POOR

1. Ability to follow instructions

2. Social skills (gets along well/respect for others)

3. Demonstrates dependability

4. Self-motivated

5. Demonstrates responsibility (directs energies toward tasks)

6. Demonstrates enthusiasm in performing assigned tasks

7. Strives for excellence

8. Punctual

9. Mentally alert (organization skills/problem-solving skills)

10. Demonstrates proper etiquette and manners

11. Personal appearance/grooming

12. Demonstrates integrity/honesty

13. Demonstrates optimism and self-respect

14. Capacity to try new ideas and increase knowledge

15. Attitude toward constructive criticism

16. Ability to adapt to change

17. Cooperates with others

18. Communication skills

19. Demonstrates attention to detail

20. Ability to set realistic goals

Do you recommend this applicant for the Work-Based Learning program? □ Yes □ No Please make additional comments on back.

______Printed Name Teacher Signature Date

Teacher: Please return this form to your school Work-Based Learning Instructional Leader

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Additional comments by Academic teacher:

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