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2024-2025 Verification of Work Based Learning 
Complete this form to have your work-based learning experience verified by your high school for the 2024-2025 School Year.

Why is a work-based learning experience an important component to becoming transition ready?
Schools have the opportunity to expose students to a variety of career pathways and careers within those pathways.  When learning is linked to real world experiences and the interests of the students, learning is reinforced.  

 How does the KCSD define work-based learning?
Any internship or workplace learning experience paid or unpaid that is directly tied to the career pathway of interest of the student.  

Some examples of work-based learning are:
-Meeting the requirements to achieve a .5 credit for work-based learning as an elective credit through your high school. Students DO NOT need to complete this form for this category. 

-Completing at least 50 hours of verified paid or non-paid work experience through a work-based learning experience.  Complete this form for this category.

Examples of a work-based learning experience are:
cooperative education
entrepreneurial program,
Internship,
Mentoring
school-based enterprises
service learning
shadowing

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Student ID Number *
First Name *
Last Name *
Grade *
High School (IGNITE/JROTC/YSA Students Choose Home High School) *
Name of Company where you completed a work based learning experience. *
Name of Supervisor (This is the person responsible for verifying your work based learning experience.) *
Supervisor Phone Number for Verification *
What is your identified career pathway? *
Describe how your work based learning experience is tied to your career pathway. *
Describe the Job Performed and Your Role in the Organization *
Number of Hours you Completed in this Experience *
Were you paid for this job? *
Beginning Date of work based learning experience *
MM
/
DD
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YYYY
End Date of work based learning experience (if you are still in this role, enter today's date). *
MM
/
DD
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YYYY
Students need to submit a resume to their School Counselor in order to verify Work-Based Learning experience.

Please submit your resume to your counselor within 5 days of completing this form. 
 *
By writing my name below, I certify that all the information I submitted is presented accurately and honestly.   *
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