2021-22 Work Based Learning Application
Please complete this form. Be sure to enter accurate information! Mrs. Parker will meet with each applicant for an informal interview. Be sure to tell the teachers you list as references to expect an email from Mrs. Parker with a recommendation form they will need to complete.
First Name *
Last Name *
Are you currently a WBL student? *
What grade will you be in during the 2021-22 School Year? *
Which semester(s) would you like to participate in the WBL program for the 2021-22 school year? *
How many blocks/periods would you like to participate in WBL1st Semester? *
How many blocks/periods would you like to participate in WBL 2nd Semester? *
What is your date of birth? *
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DD
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Street Address *
City *
Zip Code *
What is YOUR cell phone number? (please use dashes, ex. 770-123-4567) *
What is your Home Phone number? (please use dashes, ex. 770-123-4567)
What is your personal non-school email address? Be sure this is an email that you check FREQUENTLY! *
Please verify your email address (this entry should match the one entered above). *
What is your school email address? *
Who do you live with? *
What is your mother's first and last name? (can also be your guardian) *
What is your mother's (or guardian) cell phone number? Ex. 770-XXX-XXXX (use dashes please) *
Mother's (or guardian) email address: *
What is your father's first and last name? (can also be an additional guardian)
What is your father's (or guardian) cell phone number? Ex. 770-XXX-XXXX (use dashes please)
Father's (or additional guardian) email address:
Are you presently employed? *
If you are employed or have a summer job lined up, please list where.
Do you currently have or will you have a driver's license before the beginning of the 2020-21 school year? *
Do you have transportation for the 2020-21 school year? *
List the first and last name of the 1st teacher you plan to ask to recommend you for WBL. *
List the first and last name of the 2nd teacher you plan to ask to recommend you for WBL. *
Describe your career goal? *
Describe how you believe WBL can help you work toward your career goal: *
What are your immediate plans after High School? *
Are you a member of a Career Technical Student Organization (CTSO)? *
Required
I have successfully completed classes in the following areas (check all that apply): *
Required
What other programs are you planning to participate in for the 2021-22 school year? *
Required
Please list any sports or other extra-curricular activities you participate in:
How did you hear about WBL? (check all that apply) *
Required
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