Work-Based Learning/Youth Apprenticeship Application Checklist

Youth Apprenticeship (YAP)/Work Based Learning(WBL) Application Packet

2018-2019

Include the following when applying for the YAP/WBL Program:

______Completed Application______Parent Contact Information

______Essay ______Transcript

(3 Paragraph min. Why I should be considered for WBL)

______Resume______Copy of current schedule

______Three teacher recommendations______Disciplinary Report

Name ______Pathway______

HighSchool ______Do you attend Woodville Tompkins?_____

I am interested in:

Summer only ______Summer and School year ______School Year only ______

List all sports that you will be involved in during 2016-17 School Year.

Placement Site ______Start Date ______

Youth Apprenticeship Application Form

**Use Black Ink Only**

Today’s Date ______Pathway______School______

Full Name: ______Graduation year _____

Address: ______City:______Zip Code: ______

Home phone:______Cell: ______Email:______

Birth Date: ______**YOU MUST PROVIDE A VALID CELL AND EMAIL ADDRESS

Do you participate in Extra- Curricular Activities? Yes ___ No ___ Which? ______

List previous work experience,if any (starting with the most recent and working backwards):

Job Title Employer (Name)

______

Are you available for summer employment? Yes ____ No ____

Can you drive to work? Yes __ No __ If not, do you have transportation? Yes __No __

What are your plans after high school graduation? ______

______

Parent Contact Information

Primary Guardians name ______Phone # ______

Email address ______

Other Guardians Name ______Phone # ______

Email address ______

Special Skills

I am familiar with the following: Check all that apply.

Word __Excel__Powerpoint__AutoCAD__Typing __Filing __ Access ___Other special skill(s)______

SLP student? _____yes _____no Completed Explore Post? ____yes ____no

Certified in: Word _____ Excel _____Powerpoint ____ Other ______

Grading Procedures

All assignments are submitted online via Edmodo.com unless otherwise stated

Portfolio Assignments/Classwork due once a month40%
Employer Evaluations due every other month30%
Timesheets/Pay Stubs due at end of each month30%

If selected for this program it is my responsibility to:

Submit a copy of my paystubs to YAP Coordinator and/or WBL Coordinator monthly for mandated State reporting.
Communicate any problems or concerns regarding my supervisor or job assignment.
Provide my own transportation to and from the worksite.

Certification

I certify that I have completed the above application form after careful consideration. If I am selected for theYAP/WBLProgram, I will take advantage of every opportunity to improve my skills and efficiency in the classroom and in the work place.

Signature of Student: ______Date: ______

COMPLETION OF THIS APPLICATION DOES NOT GUARANTEE A JOB INTERVIEW OR ACCEPTANCE INTO THE APPRENTICESHIP PROGRAM.

Parent Signature ______Date: ______

Savannah-Chatham County Public Schools does notdiscriminate on the basis of race, color, sex, religion, national origin, age, or disability in any employment practice, educational program, or any other program, activity or service.

Work Based Learning/Youth Apprenticeship Program

Early Release Understanding/Insurance Verification Form

Student Name: ______WBL/YAP Coordinator:______

Directions: According to state guidelines, in order for a student to be enrolled in the work based learning program, the parent/guardian must provide the required information below and sign and date the form at the bottom of the page.

Early Release

I understand that my child, ______, is enrolled in the work-based learning program at High School and that my child will be dismissed from school at the end of his/her regularly scheduled on-campus classes each day.

I assume full responsibility for my child after dismissal from school, including days when my child is not required to be on the job. I also understand that my child must be covered by automobile accident and health insurance in order to drive to and from work and to be a part of the work-based learning program. (please complete information section below).

Automobile Accident and Health Insurance

I understand that my child must be covered by automobile accident and health insurance to participate in the work-based learning program. I have checked the appropriate statement regarding insurance coverage for this school year. I agree to notify the work-based learning coordinator if this coverage changes during the school year.

Automobile Accident Insurance(complete below OR provide copy of insurance card)

My child is covered by automobile accident insurance through the following provider:

Provider Policy Number

Address City, State, Zip

Name of Insured Phone Number

Health Insurance(please check one, complete below OR provide copy of insurance card)

My child is covered by health insurance purchased through the school, or

My child is covered by health insurance through the following provider:

Provider Policy Number

Address City, State, Zip

Name of Insured Phone Number

My child is NOT covered by health insurance, but I will assume responsibility for any costs related to medical treatment that may be needed.

______

Parent’s or Guardian’s Signature Date

Teacher Recommendation Form

Confidential

The Youth Apprenticeship Program is an extension of the school based curriculum into the workplace. Through this experience students are exposed to workplace knowledge and competencies, with the goal of better preparing students for future opportunities. The program is voluntary, and designed for a group of selectedstudents entering their junior/senior year.

The student listed below has applied to participate in this program. Please assist us by completing this form and returning it to the Work Based Learning Coordinator as soon as possible. Thank you.

Student Name ______

EXCELLENT / GOOD / FAIR / POOR
Ability to follow instructions
Social Skills
Self-motivated
Strives for excellence
Punctual
Demonstrates proper etiquette and manners
Personal appearance and grooming
Attitude toward constructive criticism
Ability to adapt to change
Cooperates with others

In my opinion this students is: ___shy/reserved ____average ____outgoing

Comments:

Please Print Your Name ______Date ______

Classroom extension: ______

Teacher Recommendation Form

Confidential

The student listed below has applied to participate in this program. Please assist us by completing this form and returning it to the Work Based Learning Coordinator as soon as possible. Thank you.

Student Name ______

In my opinion this students is: ___shy/reserved ____average ____outgoing

Comments:

Please Print Your Name ______Date ______

Classroom extension: ______

Teacher Recommendation Form

Confidential

The student listed below has applied to participate in this program. Please assist us by completing this form and returning it to the Work Based Learning Coordinator as soon as possible. Thank you.