Wetumpka High School

WETUMPKA HIGH SCHOOL Due to

COOPERATIVE EDUCATION Mrs. Crockett, COM1

STUDENT APPLICATION FOR ENROLLMENT

Name______Cell Phone No.

Address______Home Phone No.

Age Date of Birth______Current Grade

Do you have a driver’s license? ( ) Yes ( ) No Do you have access to a car? ( ) Yes ( ) No

Career Objective

What type of diploma are you currently working towards?

 Advanced  Standard

How many classes/credits are you interested in participating in the co-op program?

 One  Two  Three

Parent/Guardian Name(s)

Parent/Guardian Address

Parent/Guardian Business Telephone______

Indicate the type of business in which you prefer to work: (Example: bank, dental, department store, legal, manufacturing, insurance, medical, etc.)

First Choice______Second Choice______

Reason for above preference

What career/technical courses have you taken (Marketing, Ag, FACS, or Technical Center courses)?

What career/technical courses are you interested in taking next school year?

______

Do you intend to further your formal education after high school? ( ) Yes ( ) No

CURRENT GRADE POINT AVERAGE (GPA): ______

Current/Previous Work Experience

(List most recent position first.)

Employer

/

Type of Work

/

Employment Dates

Are you under a doctor’s care? ( ) Yes ( ) No Do you have any health problems which would interfere with your regular attendance on a job? ( ) Yes ( ) No If so, please explain.

List as references the names of three (3) teachers who can attest to the quality of your work. Each of these teachers MUST fill out a teacher recommendation form in order for your application to be complete.

1. ______(Career/Technical Education Teacher)

2. ______

3. ______

To the Student:

Cooperative Education provides an opportunity to be considered for employment in businesses and industries in our area. When you enroll in Cooperative Education, you indicate that you are sincerely interested in putting forth your best efforts to receive on-the-job training, and you commit to the program for the entire school year. If you accept this responsibility, please sign in the space provided.

Student Signature______Date______

To the Parent/Guardian:

Do you consent to your child entering Cooperative Education and agree to cooperate with the school and the training agency in making the training and education the greatest possible benefit to your child? If so, please indicate your support and approval with your signature. The Cooperative Education Program is a one-year commitment. By signing below, you give your child permission to participate in Co-op for the entire school year.

Parent/Guardian Signature______Date______

To Be Completed By Cooperative Education Teacher-Coordinator

Current Attendance Record: No. Absences______No. Tardies

Current Disciplinary Record: Total Reports______Cumulative GPA:

List courses that determine students’ eligibility:

Status of Application: ( ) Pending ( ) Approved ( ) Not Approved

Comments:

Date Employed Employer

Employer’s Address

Supervisor/Mentor

Telephone Beginning Rate of Pay