2000 Pioneer Parkway, Suite 19C Peoria, IL 61615
Application
Chris Kendall,Director
2000 Pioneer Parkway, Suite 19C Peoria, IL 61615
(309) 693-7373
P.E.R.F.E.C.T. RegionalConstructionWork-Based Learning Program
Deadline: March 1, 2018
Returnthisapplicationto:P.E.R.F.E.C.T.,2000PioneerParkway,Suite19C,Peoria,IL61615
Completeapplicationsmustinclude:acurrenthighschooltranscript,3faculty/counselorrecommendationsandacompleteddisciplinary/attendance form.
StudentName: CurrentGradeLevel: Sophomore Junior DateofBirth:
Gender:MaleFemale
Phone#:(home)
(cell)
(other)
HomeAddress: City,ZIP:
HighSchool:
SchoolPhone#:
SchoolAddress: City,ZIP:_
CounselorName: CounselorEmail: Did youattendthe8thGradeConstructionIndustryCareerExpo? Yes No
Acurrenthighschooltranscript,3faculty/counselorrecommendationsandacompleted disciplinary/attendanceformarerequired.
One-YearProgramSchedule:Monday-Friday,7:30a.m.-9:30a.m.
1stSemester–Classheldatvarioustradelocations
2ndSemester–Internshipswithcontractors
Mother/
NameHome PhoneWork PhoneCell PhoneEmail Address
Guardian:
Father/
Guardian:
Emergency
Contact:
RequiredSignatures:
Student signature indicates that he/she understands the transportation and academic requirements for the off-campus programwhichhe/she is applying. Parent/Guardian signature indicates that theybelievethat their son/daughter has the maturityand ability to be successful in the program, approvesof this application, ensuresstudentwill beprovided suitable transportation,and gives the school permission to release all necessaryschool records.
Student:
Parent/Guardian
Date:
To Date
FacultyMember
has expressedan interestin the
StudentName
ProgramName
program andhas listed your name as a person who isfamiliarwith her/his personality and possiblefuture success in this
Regional Career and Technical Education andWork-Based Learning program.
Your cooperation is greatly appreciated.
RatingScale(Rating Scale:5=Excellent 4=Good3=Average 2=Fair1=Poor) / 1 / 2 / 3 / 4 / 5
Professionalism - Thisstudentwillrepresentyourschoolatanoff-campussiteifthestudentisselected fortheprogram.Canthisstudentbetrustedtodressappropriatelyforthetraining?Forexample:Willthe studentwearsafetyequipmentlikesafetyglasses/boots?Canthisstudentwear“businesscasual”tothe workplaceifthatisarequirement?
Attitude -Doesthisstudentcontributeto yourclassinpositiveways?Doesthisstudenthelpothers?Does thisstudentexhibitleadershipskills?
Cooperation-Doesthisstudentworkwithothersina“team”setting?Doesthisstudenttakepartingroup workordoesthisstudentsitbackandletothersinthegroupdotheassignment?
Courtesy- Doesthisstudenttreatyouwithrespect?Doesthisstudentrespectthefeelingsofhis/herfellow students?Canthisstudentbetrustedtolearnandworkinaculturallydiverseenvironmentandnotembarrass yourschool?
Dependability - Doesthisstudenthandinassignmentsontime?Aretheydonecompletelyand thoroughly?
Initiative-Doesthisstudenteverdoextracreditworkorindependentstudywork?Doesthisstudentever
“gobeyond”thebareminimumsofassignedwork?
Promptness& Attendance - Isthisstudentusuallyontimefor yourclass?Doesthisstudentmiss more thana fewdaysforrealillness?Youarethebestjudgeofthisstudent’sabilitytobeontimeandreadyto work.Howdoesthisstudent“measureup”?
Reliability- If yougavethisstudentaprojectorassignmentto do,couldyoucountonthisstudenttohaveit completedbythedateassigned?Doesthisstudentfollowdirectionsandcompleteassignmentswitha degreeof prideinhis/herwork?
Citizenship-Willthisstudentbeapositiveambassadorfor yourschoolinthePeoriaareabusinessor highereducationcommunity?Isthisstudenta“goodcitizen”whoshowssomeleadershipinyourownschool?
COMMENTS:(Pleaseprovide a writtenstatementabout thisstudent.)
To Date
FacultyMember
has expressedan interestin the
StudentName
ProgramName
program andhas listed your name as a person who isfamiliarwith her/his personality and possiblefuture success in this
Regional Career and Technical Education andWork-Based Learning program.
Your cooperation is greatly appreciated.
RatingScale(Rating Scale:5=Excellent 4=Good3=Average 2=Fair1=Poor) / 1 / 2 / 3 / 4 / 5
Professionalism - Thisstudentwillrepresentyourschoolatanoff-campussiteifthestudentisselected fortheprogram.Canthisstudentbetrustedtodressappropriatelyforthetraining?Forexample:Willthe studentwearsafetyequipmentlikesafetyglasses/boots?Canthisstudentwear“businesscasual”tothe workplaceifthatisarequirement?
Attitude -Doesthisstudentcontributeto yourclassinpositiveways?Doesthisstudenthelpothers?Does thisstudentexhibitleadershipskills?
Cooperation-Doesthisstudentworkwithothersina“team”setting?Doesthisstudenttakepartingroup workordoesthisstudentsitbackandletothersinthegroupdotheassignment?
Courtesy- Doesthisstudenttreatyouwithrespect?Doesthisstudentrespectthefeelingsofhis/herfellow students?Canthisstudentbetrustedtolearnandworkinaculturallydiverseenvironmentandnotembarrass yourschool?
Dependability - Doesthisstudenthandinassignmentsontime?Aretheydonecompletelyand thoroughly?
Initiative-Doesthisstudenteverdoextracreditworkorindependentstudywork?Doesthisstudentever
“gobeyond”thebareminimumsofassignedwork?
Promptness& Attendance - Isthisstudentusuallyontimefor yourclass?Doesthisstudentmiss more thana fewdaysforrealillness?Youarethebestjudgeofthisstudent’sabilitytobeontimeandreadyto work.Howdoesthisstudent“measureup”?
Reliability- If yougavethisstudentaprojectorassignmentto do,couldyoucountonthisstudenttohaveit completedbythedateassigned?Doesthisstudentfollowdirectionsandcompleteassignmentswitha degreeof prideinhis/herwork?
Citizenship-Willthisstudentbeapositiveambassadorfor yourschoolinthePeoriaareabusinessor highereducationcommunity?Isthisstudenta“goodcitizen”whoshowssomeleadershipinyourownschool?
COMMENTS:(Pleaseprovide a writtenstatementabout thisstudent.)
To Date
FacultyMember
has expressedan interestin the
StudentName
ProgramName
program andhas listed your name as a person who isfamiliarwith her/his personality and possiblefuture success in this
Regional Career and Technical Education andWork-Based Learning program.
Your cooperation is greatly appreciated.
RatingScale(Rating Scale:5=Excellent 4=Good3=Average 2=Fair1=Poor) / 1 / 2 / 3 / 4 / 5
Professionalism - Thisstudentwillrepresentyourschoolatanoff-campussiteifthestudentisselected fortheprogram.Canthisstudentbetrustedtodressappropriatelyforthetraining?Forexample:Willthe studentwearsafetyequipmentlikesafetyglasses/boots?Canthisstudentwear“businesscasual”tothe workplaceifthatisarequirement?
Attitude -Doesthisstudentcontributeto yourclassinpositiveways?Doesthisstudenthelpothers?Does thisstudentexhibitleadershipskills?
Cooperation-Doesthisstudentworkwithothersina“team”setting?Doesthisstudenttakepartingroup workordoesthisstudentsitbackandletothersinthegroupdotheassignment?
Courtesy- Doesthisstudenttreatyouwithrespect?Doesthisstudentrespectthefeelingsofhis/herfellow students?Canthisstudentbetrustedtolearnandworkinaculturallydiverseenvironmentandnotembarrass yourschool?
Dependability - Doesthisstudenthandinassignmentsontime?Aretheydonecompletelyand thoroughly?
Initiative-Doesthisstudenteverdoextracreditworkorindependentstudywork?Doesthisstudentever
“gobeyond”thebareminimumsofassignedwork?
Promptness& Attendance - Isthisstudentusuallyontimefor yourclass?Doesthisstudentmiss more thana fewdaysforrealillness?Youarethebestjudgeofthisstudent’sabilitytobeontimeandreadyto work.Howdoesthisstudent“measureup”?
Reliability- If yougavethisstudentaprojectorassignmentto do,couldyoucountonthisstudenttohaveit completedbythedateassigned?Doesthisstudentfollowdirectionsandcompleteassignmentswitha degreeof prideinhis/herwork?
Citizenship-Willthisstudentbeapositiveambassadorfor yourschoolinthePeoriaareabusinessor highereducationcommunity?Isthisstudenta“goodcitizen”whoshowssomeleadershipinyourownschool?
COMMENTS:(Pleaseprovide a writtenstatementabout thisstudent.)
This form is to be completed by a school official such as the deanof students,counselor, or principal. School may substitute localform if it includes requiredinformation.
Student’sName:
Today’sDate:
Please indicate the number of days absent and tardy,per semester, recorded for student during the current school year.
1stSemester:
Days
Excused
Days
Unexcused
Tardies
2ndSemester:
Days
Excused
Days
Unexcused
Tardies
Please indicate whether student has any major disciplinaryinfractions on file. (i.e. suspension and/orexpulsion.)
No major disciplinaryactions
One or moremajor disciplinaryactions
Please attachthe followingdocuments:
Detailed attendance report
Current highschool transcript
This formwas completed by:Name: Title: Phone:
Email Address:
HSOfficial'sSignatureDatePosition