HCS District Version - Confidential Counselor Referral Form

Work-Based Learning programs are an extension of the school-based curriculum in the workplace. Through these experiences, students will be exposed to a wide range of general workplace knowledge and competencies, with the goal being to better prepare students for future opportunities. The program is voluntary and designed for a group of selected students entering their junior/senior year. The student listed below has applied to participate in Work-Based Learning. Please assist by completing this form and submitting it as quickly as possible.  Thank you

Henry County Schools does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups. You may access additional information at https://schoolwires.henry.k12.ga.us/Page/49720.

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Email *
Student's Last Name *
Student's First Name *
Student ID number
CTAE pathway(s) *
 Note: The pathway should not be confused with the name of the course.
Is this student a pathway completer? *
Is this student on track to graduate? *
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