CE Agreement Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

CE Agreement Form_2012-2013

Students: you MUST discuss your CE choice with your Advisor before you fill out this form. They need to know what you are signing up for.

Your Last Name *

Your first name *

NVHS Advisor's Name *

Alex

Andy

Anissa

Beth

Hunter

Joel

Kara

Kate

Kim

Loren

Marco

Martin

Mike

Pfouts

Susie

Tas

What is your Mentor's First and Last Name? *

What is the Business/Org Name? *

What is the Business Address? *

We need the Number, street, city, state, and zip code PLEASE!

What is the Business Phone # ? *

What is the email address of your mentor? *

What is the expected day of this CE? *

Wednesday is preferred but any other day that you and the mentor agree to are fine as long as it does not interfere with your school schedule.

What are the expected hours of this CE? *

The length of time should be between 2- 4 hours per week. You will earn credit for the hours your complete. Min of 6 hrs/qtr. Max of 60 hrs/qtr.

Provide a brief description of your goals, specific tasks and expectations at this Community Experience placement. *

You may write sentences or create a bulleted list of responsibilities (together with your mentor).

Are you also registered for a WORKSHOP during this quarter? *

Yes, I should be registered for BOTH a workshop AND a CE.

No, I am not registered for a WORKSHOP, I will only have this CE

Yes, I am registered for a WORKSHOP but want to drop the WORKSHOP for this CE

Other:

If you are registered for a WORKSHOP and want to be dropped from it, you must speak with Cheryl personally to make this happen. *

Acknowledge this below and check ALL that apply.

I will personally speak with Cheryl at her desk to request that my workshop is dropped from my schedule.

I understand that each student's scenario is different and that is why a conversation is required to add or drop a student from any class including WORKSHOPS and CEs.

This question does not apply to me because...fill in the answer in the "Other" box below.

Other:

Required

Thank you for taking the time to carefully fill this out. Student, please submit this to Cheryl McBay by the due date. We will send along further information about on-site injury, attendance, grading, problem solving, etc. to the Community Mentor. *

Please check the box to acknowledge that you read this statement.

I have read this statement

Required

CE Evaluations will be sent to the Community Mentor, one week before the end of each quarter. Mentors should email the evaluation to students AND to Cheryl McBay by the end of the quarter. This will allow us to give credit in a timely fashion. *

Please check the box to acknowledge that you read this statement.

I have read this statement

Required

Students must keep track of their hours *

Cheryl has time sheets to record your hours or you may use your phone or other planner.

I have read this statement

Required

Grading is Satisfactory/ Unsatisfactory and you will receive credit based on the # of hours that you complete. *

15 hours=0.25 credit 30 hours=0.5 credit. Your goal should be 30 hours per quarter.

I have read this statement

Required

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Boulder Valley School District. Report Abuse

Forms