2000 Pioneer Parkway, Suite 19C Peoria, IL 61615

Application

Chris Kendall,Director

(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.

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.

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