Work Based Learning Participation Contract/ Interest Survey

Student's Last Name *

Student's First Name *

Student's Email *

Re-enter Student's Email *

Student's Cell Phone Number *

Can this number receive text? *

Yes

No

Student's Birth Date (mm/dd/yyyy) * +

Student's Age: *

Home Street Address *

City *

State *

Zip Code *

Home School: *

Are you in a Career Pathways program? *

Instructor *

Counselor *

Program/Course *

Work Based Learning is a continuum, of activities that occur, in part or in whole, in the workplace, providing the learner with hands-on, real world experience

The Work Based Learning (WBL) school-to-career programming includes technical education, rigorous academics, employability training, in-industry work and mentoring experience. Employers who participate in Colorado Springs School District 11's WBL programming mold future industry employees to develop important employable skills such as professional skills and business and industry specific technical skills. Ultimately, upon graduation, students will be eligible to be hired in an entry-level position in your business/industry and/or prepared to continue into post-secondary education.

Job Shadow: A Job Shadow visit is generally a ½ day-full day opportunity, designed to give students deeper insight into a trade. Students may follow one employee or split the job shadow experience so that they follow more than one employee who serve different roles at a business.

School Based Enterprise (Instructor Sponsored/Developed): A School-Based Enterprise (SBE) is an entrepreneurial operation in a school setting that provides goods/services to meet the needs of the market. Many SBE’s are facilitated/supervised by an instructor. SBEs are managed and operated by students as hands-on learning experience.

Industry Sponsored Project (Industry Partnered Sponsored): An Industry Sponsored Project (ISP) is a community partnership where students complete a project that has been approved by the instructor and community partner. Students receive constant feedback and mentoring with the community partner to ensure the project’s success. Students will need to outline; purpose, outcomes, timeline, and etc. ISP’s are approved and monitored by the classroom instructor. At the end of the completion of the project students will need to present their final product to a panel of individual and explain the process/steps in which needed to take place. Students who wish to earn high school elective credit must accumulate 60 or 120 hours.

Internship (Teacher or WBL Coordinator Sponsored): An Internship is a real-world opportunity to expose students to the requirements, the work environment, as well as behavioral expectations to succeed on the job. These work experiences are not expected to provide formal training, but can be parallel training students are receiving in their Career and Technical Education class(es).

Students generally participate in an internship for 60 or 120 hours. Students in a co-curricular opportunity can earn high school credit (every 60 hours=1 PWR credit). Employers may modify hours if deemed necessary. The expectation is that students are at their internship site 3-5 hours/days over multiple weeks. This opportunity will be facilitated by an instructor (cooperative) or WBL school site liaison and/or District WBL Coordinator (co-curricular), who will provide support and evaluations in order to ensure this is a positive experience for both the employer and student. This allows the employer a support system to help ensure this experience is meeting their needs and expectations. These WBL opportunities could be paid/unpaid/stipend (after completion of hours).

Credit for Work (WBL Coordinator Sponsored): A Credit for Work (CFW) opportunity allows students to have a real-world experience in different career pathways while earning elective credit(s) towards graduation. These CFW experiences are taking place outside their Career and Technical Education class(es). Students MUST get approved by the District WBL Coordinator or the WBL School Site Liaison.

Interested In (choose as many as you would like)/(past summer opportunities-click which one you did): *

Job Shadow

School Based Enterprise

Industry Sponsored Project

Internship [Cooperative: a part of a class] (60 hours)

Internship [Cooperative: a part of a class] (120 hours)

Internship [Co-curricular: outside of a class] (60 hours)

Internship [Co-curricular: outside of a class] (120 hours)

Credit for Work/Work Study (60 hours)

Credit for Work/Work Study (120 hours)

Semester (choose as many as you would like) *

Summer 2023

Fall 2023

Spring 2024

Summer 2024

STUDENT AVAILABILITY (When can you work) *

Student understanding of agreements. Each item below needs to be checked. By checking each item, you acknoledge that you understand each agreement. We cannot process incomplete forms. If you need to discuss an item, please contact District 11 work based learning at 719-328-2164. *

I understand if I am terminated by the employer and/or school district another work based learning opportunity will NOT be provided

I understand that to be considered for and during a work based learning opportunity, I cannot be absent (unexcused) 10 or more times during the school year.

I understand that I will be and will continue to be passing all my classes (cooperative maintain a B or better in CTE classes)

I understand that Colorado School District 11 is NOT providing transportation to or from work based learning opportunities. I will need to transport myself or arrange for transportation.

I understand that I should NOT transport another student to and from work based learning opportunities

I give permission for D11 to share my contact information (email and/or phone number), with the intention of arranging times/dates for work based learning opportunities. D11 only shares student information with approved industry partners and strives to be included communications that develop between students and industry partners while placement is being discussed.

Emergency: Parent/Guardian Name *

Emergency: Parent/Guardian Phone Number *

Can this number receive text? *

Yes

No

Emergency: Parent/Guardian Email *

Re-enter Emergency: Parent/Guardian Email *

I give permission to be photographed or videoed during this event; this may include being spotlighted on the D11 social media sites *

Yes

No

Transportation: (how is the student getting to and from their WBL opportunities) *

What program(s)/course(s) are you interested in for a work based learning experience? *