Scott County High School Cooperative Education

Scott County High School Cooperative Education

Work-Based Learning Plan / Guidelines

In order to be more successful in my career and continual educational training, I understand that my attendance, attitude, and work are essential to learning.

I, ______, agree to the following statements, and understand that violation of such may result in the possible recommendation that my work based learning be terminated. I also understand that termination of my work-based learning may result in no credit being awarded for this career and continual education class and / or failing of the Work-Based class.

Failure to abide by the contract could result in termination of work-based learning position and school discipline following Scott County High School code of conduct.

THE STUDENT AGREES TO:

Get approval from either the Work-Based Learning teacher/coordinator or counselor before taking part in the work-based learning program. Provide the following documentation: copy of driver’s license, car insurance, and medical insurance.
Obtaining a parking permit and signing a drug use policy.
The fact that the cooperative work-based learning program is a privilege, not a right.



Maintain a job throughout the school year and abide by the Work-Based Learning Plan.
Never resign from the job without the consent of the work-based teacher or coordinator, and then only after the necessary arrangements have been made with the employer, including a two week written notice. You must have secured a new job before you quit your current job!
Maintain a record of performance and hours worked on a weekly or bi-weekly basis, by providing a paycheck stub to the Work-Based coordinator on a regular schedule.
Work a minimum of 15 hours per week. (135 total hours for a nine week period) see grading rubric below for grading scale.

135 or more = 100% / 134 hours to 130 = 96% / 129 hours to 125 = 93% / 124 hours to 120 = 89% / 119 hours to 115 = 85%
114 hours to 110 = 81% / 109 hours to 105 = 78% / 104 hours to 100 = 74% / 99 hours to 95 = 70% / 94 hours to 90 = 67%

Discuss with the Work-Based Learningteacher or coordinator immediately any problems with shift change, work-based learning changes or problems that arise on the job.
Attend school regularly. If you do not attend school, you can not go to work that day. Understand that an absence from a scheduled workday is an absence from school. No more than three unexcused absences from school per semester.
Conform to Scott County High School policies and regulations as well as the employer’s. Failure to do so will result in disciplinary action.
Keep the employer’s interest in mind and be punctual, dependable and loyal.
The policy that you must pass the Work-Based Learning class in order to receive any credit.
Actively participate in classroom activities including working to meet ACT benchmarks.
The fact that if the student is not passing their core content classes at semester, it will be left up to the discretion of the school administration on whether the student will remain in the program. It is important that the student understand that graduation at the end of the year is the main goal of this program.
Leave the school’s campus after your last class for the day. You must have reliable transportation every day, failure to do so will result in being dismissed from the program.

THE TEACHER / COORDINATOR, ON BEHALF OF THE SCHOOL AGREE TO:

Visit the student on the job to determine instructional needs and to insure that the student is receiving job training and supervision.

Recognize that information gathered at the company is confidential.
Make provisions for the student to receive prior or concurrent related instruction on a regular basis.

THE PARENT OR GUARDIAN AGREES TO:

Accept responsibility for the student’s safety and conduct while traveling to and from school, place of employment and/or home.
Provide daily reliable transportation for the student to their work. If transportation can not be provided by parent/guardian or student they will be removed from program. Students can not remain in building after their last schedule class.
Riding with another student will not be permitted.
Support the concepts outlined in the work-basedprogram.

THE EMPLOYER AGREES TO:

Take an active part in training and supervising this student while providing on-the-job instruction.
Provide safety training as regulated by OSHA.
Provide close supervision by an experienced and qualified person to avoid subjecting the student to unnecessary or unusual hazards.
Notify the parent and the school immediately in case of accident, sickness or any other serious problems.
Provide a minimum of 15 hours of employment per week to the student-trainee.
Pay student-trainee when an employer/employee agreement is negotiated.
Give the same consideration to the student as given to other employees in regard to safety, health, general employment conditions and other regulations to the business.
Comply with all regulations prohibiting discrimination on the basis of race, color, national origin, sex, disabilities, religion, marital status or age.
Notify Scott County High School Work-Based coordinator of any discipline problems or dismissal of employment.

If this agreement is for a paid work-based learning agreement, the employer certified that this student is covered by Worker’s Compensation Insurance and that the policy is now in force and registered with the Department of Workers Claims in Frankfort, KY as prescribed by law (KRS 342.630) (or with the appropriate agency if outside of Kentucky).

Copies sent to: ______Employer ______Student ______Parent ______Teacher/Coordinator

______

Student’s SignatureDatePlace of Employment (Print)Date

______

Parent/Guardian Signature(under 18 yrs of age)DateEmployer’s Signature Date

Please print Employer’s Name: ______

I grant permission to photograph my son/daughter while participating in the Work Based programfor promotion and educational purposes. ______Yes ______No

Scott County High School Use Only

______

Coordinator/Teacher SignatureDate

Scott County High School

Work-Based Agreement

Student/Parent/Work Place Information

Please PRINT and complete the following information in black or blue ink:

Student’s Last Name: ______First Name: ______

(Please Print) (Please Print)

Date of Birth: ______Age: ______

Address: ______City: ______

Home Phone Number: ______State: ______Zip Code: ______

StudentCell Number: ______E-Mail: ______

Parent/Guardian’s Name:______

Address: ______City: ______

Parent Cell Number: ______State: ______Zip Code: ______

Email: ______

School: Scott County Schools Phone: 863-4131

Address: 1080 Cardinal Drive City: Georgetown State: Kentucky Zip Code: 40324

Program Area: Work-Based Learning / Cooperative Education

Teacher: Kevin Howard – phone 863-4131

Coordinator’s Name: Kevin Howard_- phone 863-4131

Please Print Information Below:

Company/Business Name: ______Phone: ______

Address: ______

Business Email: ______

City: ______State: ______Zip Code: ______

Human Resource Manager’s Name: ______

Owner/Manager: ______

Student’sStart Date: ______Approx. # hours per week: ______

Student’s Work Schedule(days & hours): ______

Duties & Responsibilities: ______

*Website for students to obtain paychecks stubs: ______

*Websitesmay have to be unblocked by Scott County Schools Central Office for students to access.

Scott County High School complies with all federal regulations prohibiting discrimination on the basis of race, color, national origin, sex, disabilities, religion, mental status, age, or handicap in matters pertaining to admissions, employment and access to programs.

Equal Education and Employment Opportunities M/F/D

Scott County High School

Work-Based Learning

Medical Authorization

(This form must be signed by parent or guardian!)

Should it be necessary for my child to have medical treatment while participating in the Work-Based program, I hereby give the school district and/or worksite personnel permission to use their best judgment in obtaining medical services for my child, and I give permission to the physician selected to render whatever medical treatments he/she deems necessary and appropriate. ______YES ______NO

Permission is also granted to release emergency contact/medical history to the attending physician or to worksite personnel if needed. ______YES ______NO

Student’s Name (Please Print) ______

Date of Birth: ______

Address: ______

Parent/Guardian’s Name (Please Print) ______

Cell Phone Number: ______

Daytime Phone for parent/guardian: ______

Contact other than parent or guardian: ______

Relationship to student: ______Phone: ______

Family Doctor: ______

Preferred Hospital: ______

Phone Number to Hospital: ______

Does your child require any special accommodations due to medical limitations, allergies, disabilities, dietary constraints, or restrictions? Please explain any that are required.

______

Parent/Guardian SignatureDate

Scott County High School

Addendum for Student Learner in Hazardous Occupation

AndCooperative Education Training Plan

(Minors under 18 years of age)

HAZARDOUS OCCUPATIONS PROHIBITED FOR MINORS:

Occupations in or about Plants or Establishments Manufacturing or Storing Explosives or Articles Containing Explosive Components.
Motor Vehicle Driver and Outside Helper on a motor vehicle.
Coal Mine Occupations.
Logging or Sawmill Operations.
Operation of Power-Driven Woodworking machines.*
Exposure to Radioactive Substances.
Operation of Power-driven hoisting apparatus, including forklifts.*
Operation of Power-Driven Metal Forming, punching, and shearing machines.
Mining, other than coal mining.
Operating power-driven meat processing equipment, including meat slicers and other food slicers, in retail establishments (such as grocery stores, restaurants, kitchens, and Delis), wholesale establishments, and most occupations in meat slaughtering, packing, processing, or rendering.*
Operation of Power-driven bakery machines including vertical dough or batter mixers.
Power-driven paper products machines including scrap paper baler and cardboard box compactors.*
Manufacturing bricks, tile, and kindred products.
Operation of power-driven circular saws, band saws and guillotine shears.*
Wrecking, demolition, and shipbreaking operations.
Roofing operations and all work on or about a roof.*
Excavating Operations.*
In, about or in connection with any establishment where alcoholic liquors are distilled, rectified, compounded, brewed, manufactured, bottled, sold for consumption or dispensed unless permitted by the rules and regulations of the Alcoholic Beverage Control Board (except they may be employed in places where the sale of alcoholic beverages by the package is merely incidental to the main business actually conducted).
Pool or Billiard Rooms

EXEMPTIONS

Exemptions may be made for Hazardous Occupations identified by an asterisk (*) in the above list for student learners who are enrolled in Cooperative education program through a written agreement with the recognized local educational authority.

DEFINITION OF STUDENT LEARNERS

A student learner is an individual who is enrolled in a course of study and training in a cooperative vocational program under a recognized state or local education authority.

GUIDELINES FOR WRITTEEN AGREEMENT

The addendum to the Work-Based Learning Plan/Agreement must:

Be attached to the official Work-Based Learning Agreement
Identify the hazardous occupations in which the student is participating
Specify tasks to be performed in the Co-op placement and identify those tasks which are identified as hazardous
Identify types of supervision required at the work site (i.e. general and direct). Direct on-site supervision

is required when using hazardous equipment

Ensure that student has completed appropriate skill and safety training to be able to perform specified task at entry-level employment status.

Scott County High School

Work-Based Learning

Written Agreement for Hazardous Occupations

(This form needs to be filled out only if student is a minor and working in a hazardous occupation.)

Job Title Hazardous Occupation and Exemption *

______

Identify tasks to be performed at work-site Identify hazardous tasks to be performed at work-site

SUPERVISION

Identify areas of general supervision to be provided for the student learner at the work site.

______

Identify areas where direct supervision is to be provided for the student learner performing hazardous tasks at the work site:

______

This agreement is an exemption from Child Labor Order #______* from the identified hazardous occupation list. This exemption is effective when all parties abide by the terms of this agreement.

______

Principal Signature Date

______

Teacher/Coordinator Signature Date

______

Supervisor (Work) Signature Date

______

Parent/Guardian Signature Date

*Refer to the number identified with an asterisk on previous page.