LEVITTOWN PUBLIC SCHOOLS Gerald R. Claps Career and Technical Center

LEVITTOWN PUBLIC SCHOOLS

Gerald R. Claps Career and Technical Center

150 Abbey Lane

Levittown, New York 11756-2997

(516) 434-7110

Work Based Learning District Response Form

TO: Home District Counselor

FROM: GC Tech Work Based Learning Coordinator Dan Luna

SUBJECT: The student named below has met GC Tech work based learning eligibility requirements and been recommended by his/her CTE teacher for the indicated work-based learning experience:

( ) Cooperative Education Program

OR

( ) Internship

Your input is requested to determine home school student eligibility. Please complete and return the following form. Should you have any questions, you may contact me at the number listed below.

DATE:______

STUDENT NAME:______

GC TECH PROGRAM:______

This will confirm that this student meets the criteria that I have checked below:

_____Is expected to meet academic requirements for graduation in June, 201_.

_____Has not exceeded four unexcused absences at home school, in the previous quarter.

_____Has no or minimal behavior issues-If minimal please comment below

Additional Comments:

______

Name: (Print) ______Title: ______

Telephone #: ______School District/Home School : ______

Signature: ______Date: ______

PLEASE RETURN THIS FORM TO:

Daniel Luna, Work Based Learning Coordinator

Telephone: (516) 434-7110 Fax: (516) 861-4408

Email: