Henry County Schools



Work-Based Learning Program#ExpectExceptional SY 2020-2021 Application PacketStudents must be pre-approved by the Work-Based Instructional Leader before placement into the program. School-Based Program FacilitatorsWork-Based Instructional LeaderMrs. Tina Walcott tina.walcott@henry.k12.ga.usDutchtown High School CounselorMrs. Tamicia Johnson770-515-7510Work-Based Instructional LeaderMrs. Dwanda Brewdabrew@henry.k12.ga.usEagle’s Landing High School Counselor Ms. Elisha Parker 770-954-9515Work-Based Instructional LeaderMrs. Melissa Robertsmelissa.roberts@henry.k12.ga.usHampton High School CounselorMs. Shirley Tarver 770-946-7461Work-Based Instructional LeaderMs. Regina Shepardregina.shepard@henry.k12.ga.usMcDonough High School CounselorDr. Dawn Lawhorn 770-957-3943Work-Based Instructional LeaderMr. Rod Pipkinrpipkin@henry.k12.ga.usLocust Grove High School CounselorMrs. Cindy Oliver770-898-1452Work-Based Instructional LeaderMrs. Gail Chapmangail.chapman@henry.k12.ga.usLuella High School CounselorMs. TaMesha Hickey770-898-9822Work-Based Instructional LeaderMr. Joey DiNinojoey.dinino@henry.k12.ga.usOla High School CounselorMs. Ann Waiting770-288-3222Work-Based Instructional LeaderMrs. Deborah Gilliam deborah.gilliam@henry.k12.ga.usStockbridge High School Counselor Dr. Omi Dobbins770-474-8747Work-Based Instructional LeaderMrs. Kathy Spiveykathy.spivey@henry.k12.ga.usUnion Grove High School CounselorMrs. Amy Morris678-583-8502Work-Based Instructional LeaderMr. Rudy Tabaresrudolph.tabares@henry.k12.ga.usWoodland High School CounselorMs. Tracy Glenn770-389-27843318510105410Christina Hinz, CTAE SupervisorHenry County Schools401 E. Tomlinson St.McDonough, GA 30253770-320-7997 Fax: 678-610-5853christina.hinz@henry.k12.ga.us00Christina Hinz, CTAE SupervisorHenry County Schools401 E. Tomlinson St.McDonough, GA 30253770-320-7997 Fax: 678-610-5853christina.hinz@henry.k12.ga.us0635000Henry County Schools does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups.? You may access additional information at .Student Checklist Write your name where indicated on all plete 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 GAfutures accountBe 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 ChecklistCompleted application formParental signature on Parental Consent Form Academic teacher recommendation formCareer Tech teacher recommendation formCounselor formCompleted CTAE/Advanced Academic/Fine Arts/World Languages coursework in ______________________ (pathway)GAfutures updated accountHenry County Schools does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups.? You may access additional information at .Student InformationStudent 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__________________Text Messages? □ Yes □ NoParent Cell Phone____________________ Parent Email__________________Parent Cell Phone____________________ Parent Email__________________Date of Birth _______________Age on August 1, 2020__________Which periods do you want to be released from school? Circle all that apply:1st2nd3rd4th5th6th7th Please list any related courses you have completed (i.e. Career Tech classes/pathways), work experience, or training and skills you have:___________________________________________________________________________________________________________________________________________________________________________________________________Please list your school/community activities, honors received and offices held:_________________________________________________________________Briefly explain why you want to participate in the Work-Based Learning program:_________________________________________________________________Occupational Goal: _________________________________________________________________Where do you plan to pursue post-secondary training? _________________________________________________________________2204085141605Be sure to complete the other side!00Be sure to complete the other side!Henry County Schools does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups.? You may access additional information at .Student Information (continued)Employment Information NOTE: Current employment is NOT a requirement in order to apply for Work-Based Learning. List all work experience (list current job first):Date FromDate ToCompanyJob TitleSupervisorList 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 □ NoDescribe the vehicle you will be using to participate in the Work-Based Learning program. Make _______________Model ______________________Tag #_________________License # ____________Insured by ______________ Traffic violations? □ Yes □ NoIf 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 □ NoYou must maintain your own transportation, insurance, and a valid Drivers License to remain in the program.Please answer all the following questions: 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? ______________________________________________________________________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 □ NoIf yes, describe __________________________________________ __________________________________________________________________________Henry County Schools does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups.? You may access additional information at GuidelinesAs a condition for acceptance into Work-Based Learning (WBL) Programs, and to remain in the program, I agree to the following: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.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.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.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.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.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.I will obtain permission from the WBL Instructional Leader before changing employment. I understand that all work sites/job locations must be approved by the WBL Instructional Leader.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.I will notify the WBL Instructional Leader of any school or work related problems that might affect my ability to maintain my employment.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.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.I realize that I am expected to contribute to the countywide end-of-year Employer Appreciation recognition activity._____________________________________________________________________________Student Signature DateHenry County Schools does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups.? You may access additional information at .Parental Consent Form3330575107315(Insert Student’s Name)00(Insert Student’s Name)It is my understanding that my child,_________________________________ 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 2020-2021 school year._________________________________________ ____________________Parent/Legal Guardian SignatureDate(Must be signed and returned with completed application packet for consideration)153733526670For more information, please refer to FAQ’S regarding Work -Based Learning (next page)00For more information, please refer to FAQ’S regarding Work -Based Learning (next page)Henry County Schools does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups.? You may access additional information at Frequently Asked Questions [FAQ’s] about Work-Based LearningWhat 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, andExperience 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, andImprove 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. Henry County Schools does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups.? You may access additional information at .540956593980Student: fill in only name and ID #00Student: fill in only name and ID #Counselor Confidential Referral FormStudent’s Name __________________________ Student ID # _____________Is this student on track to graduate (please circle)? YES NO If not, what courses are necessary to place student back on track:_____________________ ____________________ _____________________CTAE pathway: ___________________ Completer (please circle) YesNo28003573660Projected 2020-2021 Course Request (Required)______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Alt: _________________________________Alt: _________________________________Alt: _________________________________Please list alternate courses for student in the event that WBL is not an option for this student.00Projected 2020-2021 Course Request (Required)______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Alt: _________________________________Alt: _________________________________Alt: _________________________________Please list alternate courses for student in the event that WBL is not an option for this student. _____________________________________________ ___________________ Counselor Signature DateCounselor: Return this form to your Work-Based Learning Instructional Leader. Henry County Schools does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups.? You may access additional information at .Additional comments by counselor:CONFIDENTIAL CTAE/FINE ARTS 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 your 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.EXCELLENTGOODFAIRPOOR1.Ability to follow instructions2.Social skills (gets along well/respect for others)3.Demonstrates dependability4.Self-motivated5.Demonstrates responsibility (directs energies toward tasks)6.Demonstrates enthusiasm in performing assigned tasks7.Strives for excellence8.Punctual9.Mentally alert (organization skills/problem-solving skills)10.Demonstrates proper etiquette and manners11.Personal appearance/grooming12.Demonstrates integrity/honesty13.Demonstrates optimism and self-respect14.Capacity to try new ideas and increase knowledge15.Attitude toward constructive criticism16.Ability to adapt to change17.Cooperates with munication skills19.Demonstrates attention to detail20.Ability to set realistic goalsDo you recommend this applicant for the Work-Based Learning program? □ Yes □ NoPlease make additional comments on back._______________________ _______________________________ _____________Printed Name Teacher Signature DateTeacher: Please return this form to your Work-Based Learning Instructional Leader.Additional comments by CTAE teacher: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 your 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.EXCELLENTGOODFAIRPOOR1.Ability to follow instructions2.Social skills (gets along well/respect for others)3.Demonstrates dependability4.Self-motivated5.Demonstrates responsibility (directs energies toward tasks)6.Demonstrates enthusiasm in performing assigned tasks7.Strives for excellence8.Punctual9.Mentally alert (organization skills/problem-solving skills)10.Demonstrates proper etiquette and manners11.Personal appearance/grooming12.Demonstrates integrity/honesty13.Demonstrates optimism and self-respect14.Capacity to try new ideas and increase knowledge15.Attitude toward constructive criticism16.Ability to adapt to change17.Cooperates with munication skills19.Demonstrates attention to detail20.Ability to set realistic goalsDo you recommend this applicant for the Work-Based Learning program? □ Yes □ NoPlease make additional comments on back._______________________ _______________________________ _____________Printed Name Teacher Signature DateTeacher: Please return this form to your Work-Based Learning Instructional Leader.Additional comments by Academic teacher: ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download