SCHREIBERHIGH SCHOOLLast Name, First Name

Senior Experience Final ProposalTeacher or Mentor

Part I: Contact Information

NAME ______HOME PHONE ______

EMAIL ADDRESS______CELL PHONE ______

(including Area Code)

ADDRESS______

CITY, STATE, ZIP ______

Name of Faculty Mentor______

Project Title and/or Major Subject Area______

Name of Community Sponsor ______Email______Phone______

(including Area Code)

Sponsor’s Title or Position ______

Location (company or institution) of project ______

Address ______

City, State, Zip ______

Phone where you can be reached during the project (including area code)______

(including Area Code)

  1. Will you be working with other students on your project? Yes No

If yes, list those students with whom you will be working:

  1. How long and in what capacity have you known your Community Sponsor?
  1. Have you ever worked for this person or company before? Yes No

If yes, when and in what capacity?

  1. Does any relative work at, own or manage this business? Yes No

If yes, describe his/her relationship to you and his/her position and responsibilities

Part II: Informational Interview

Please set up an informational interview with your Community Sponsor to learn more about your topic. Please type their responses to the following five questions and a sixth one which you created.

  1. Please explain your career path. What degrees, certifications, or prior jobs have you held?
  1. What are the most enjoyable aspects of your job? What are the most challenging aspects of your position?
  1. Did any specific event or experience influence your career choice?
  1. What future trends do you foresee in this field?
  1. What important advice would you have for people who are interested in pursuing this profession/activity?

Part III: Project Goals

Goals should be developed with your Schreiber Mentor. In December, you should make an appointment for January to visit your Community Sponsor on-site to approve your goals before submitting this proposal on ______.

What three goals do you plan to accomplish during your Senior Experience? You may include more than three goals but no less than three. Remember – your goals need to be specific achievements you can realistically accomplish.

Goal 1:

What Tangible proof will you present to demonstrate that you have achieved this goal?

Goal 2:

What Tangible proof will you present to demonstrate that you have achieved this goal?

Goal 3:

What Tangible proof will you present to demonstrate that you have achieved this goal?

Part IV: Project Description

Briefly describe the nature of your project and number and list the specific activities in which you will be engaging.(What, in detail, will you actually be doing during Senior Experience to fulfill your goals.)

Part V: Project Schedule

  1. Students must work a minimum of 4hours,per week for the months of February, March, April, and May not including school holiday weeks. These hours do not include lunch breaks.
  1. If, for any reason, this Project schedule changes from the plans listed below, students must contact the Schreiber Mentor and the Community Sponsor.
  1. Complete the weekly time schedule below with planned hours and locations for the first four weeks of the project:

Activity Days & Hours Project Site

Week #1
Week #2
Week #3
Week #4

Total Hours:______

Part VI: PROPOSAL SIGNATURE PAGE

Student- Mentor – Parent - Sponsor

SENIORS:

YOU MUST RETURN THIS FORM ALONG WITH THE FINAL DRAFT OF YOUR PROPOSAL DIRECTLY TO YOUR TEACHER OR TO THE SENIOR EXPERIENCE OFFICE BEFORE YOUR PROPOSAL WILL BE READ FOR APPROVAL.

We have worked together in the development of ______‘s Senior Experienceproposal and agree to its terms.

______

Student’s Name (Please Print)Student’s Signature

______

Mentor’s Name (Please Print)Mentor’s Signature

___

Parent Signature

I have read my child’s proposal, I have spoken to my child’s mentor, and I agree with theplan. I understand the satisfactory completion of Senior Experience is a requirement forgraduation.

______

Parent’s Name (Please Print) Parent’s Signature

______

Parent’s telephone

___

Sponsor Signature

I have assisted in the development of ______‘s SeniorExperience proposal.

I have read it as well as the attached “Sponsors’ Role,”I understand my responsibilities,andI agree to fulfill the obligations of this role. I am at least 25 years of age. We have created the student’s goals and discussed our mutual expectations. Furthermore, I agree not to remunerate this student in any way, now or in the future, for services rendered during this project.

See: ROLE OF SPONSOR

______

Sponsor’s Name (Please Print) Sponsor’s Signature

Part VII: Senior Experience Parent Waiver

Your son or daughter has chosen to participate in SchreiberHigh School’s Senior Experience program. The Senior Experience provides an opportunity for students to plan and engage in independent activities. Given the independent nature of the projects, District personnel cannot monitor and supervise on-going project activities, many of which may take place off-campus or outside normal school hours. Consequently, it is important for parents to be aware of and to monitor the activities in which their student is engaged as part of their project and to set appropriate limits on such activities in order to protect the health and safety of their student and others who may be impacted.

Students may choose between on and off campus activities. For those students who voluntarily choose an off-campus activity, they must provide their own transportation. Liability and insurance coverage is the responsibility of the driver and/or owner of the vehicle. In order for your child to participate in the senior experience, this form must be completed and returned prior to the beginning of the Experience.

Permission to Participate and Release

My son/daughter, may (NAME)

participate in the Senior Experience program. I have reviewed the Project proposal and have discussed with him/her the likely risks and responsibilities associated with the Project.

I understand that part or all of the Project may be carried out off-campus and/or outside normal school hours. I also understand that transporting my son/daughter to project activities will be solely my responsibility if my child chooses an off-campus experience.

Parent/GUARDIAN SignatureDate

Parent/Guardian NameTelephone

Part VIII: Contract/Signature Form

A.The student agrees:

  • to follow the Project Guidelines
  • to meet with the SchreiberSenior Experience Mentor face to face once per cycleduring Senior Experience
  • it is his/her responsibility to notify all coaches and sponsors regarding the schedule for the Project
  • to successfully complete all the requirements of the Senior Experience as a requirement for graduation
  • to not be paid for work on Senior Experience
  • to not sell products created during Senior Experience within six months after the end of Project
  • to not work or volunteer in a position in which a relative is in a direct line of responsibility or in an area or department in which a relative works
  • to not work or volunteer in the same capacity or with the same supervisor in a place of business where s/he has previously been employed or has volunteered
  • that Schreiber High School is not liable for any injuries that s/he may sustain as a result of this Project

______

Student SignatureDate

B.Parents/Guardians

I have read the Senior Experience Proposal and I have discussed the Project’s schedule with my child. I understand that SchreiberHigh School cannot directly supervise my child and that SchreiberHigh School is not liable for any injuries sustained as a result of this Project. I approve my son’s/daughter’s participation in this Project and I have signed the parent waiver (Part VII).

______

Parent SignatureDate

C.Schreiber Mentor

I accept the role of SchreiberSenior Experience Mentor for ______if his/her Project is accepted as proposed. I have read the goals in this Proposal and I find them to be realistic and measurable. I will contact the Community Sponsor before this student begins his/her Project; I will meet with the student face to face once per 6 day cycle during the Project; and I will be willing to give assistance and encouragement to this student as needed throughout the Project.

______

Schreiber Mentor SignatureDate

D.Community Sponsor

______has given me a copy of “The Role of the Community Sponsor” or I have read it online and I agree to fulfill the obligations of this role. I am at least 25 years of age. We have created the student’s goals and discussed our mutual expectations. I have read his/her Senior Experience Proposal and I have approved it. Furthermore, I agree not to remunerate this student in any way, now or in the future, for services rendered during this Project.

______

Community Sponsor SignatureDate

1