2018-19 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 *
Your answer
Last Name *
Your answer
Are you currently a WBL student? *
What grade will you be in during the 2018-19 School Year? *
What is your date of birth? *
MM
/
DD
/
YYYY
Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
What is YOUR cell phone number? *
Your answer
What is your Home Phone number?
Your answer
What is your email address? Be sure this is an email that you check FREQUENTLY! *
Your answer
Please verify your email address (this entry should match the one entered above). *
Your answer
Who do you live with? *
What is your mother's first and last name? (can also be your guardian) *
Your answer
What is your mother's (or guardian) cell phone number? Ex. 770-XXX-XXXX (use dashes please) *
Your answer
Mother's (or guardian) email address: *
Your answer
What is your father's first and last name? (can also be an additional guardian)
Your answer
What is your father's (or guardian) cell phone number? Ex. 770-XXX-XXXX (use dashes please)
Your answer
Father's (or additional guardian) email address:
Your answer
Are you presently employed? *
If you are employed or have a summer job lined up, please list where.
Your answer
Do you currently have or will you have a driver's license before the beginning of the 2018-19 school year? *
Do you have transportation for the 2018-19 school year? *
List the first and last name of the 1st teacher you plan to ask to recommend you for WBL. *
Your answer
List the first and last name of the 2nd teacher you plan to ask to recommend you for WBL. *
Your answer
Describe your career goal? *
Your answer
Describe how you believe WBL can help you work toward your career goal: *
Your answer
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 2018-19 school year? *
Required
Please list any sports or other extra-curricular activities you participate in:
Your answer
How did you hear about WBL? (check all that apply) *
Required
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