2021-2022 Statesboro High WBL Application
Applications will be reviewed and all applicants will be ranked based on discipline, attendance, grade point average, and teacher recommendations.

Student Requirements
• parent approval to apply to the program
• a clearly defined career goal
• a good attendance record, no more than 5 unexcused absences or 5 tardies the semester prior to application to Work Based Learning
• a good academic record and be on track for graduation (All students must have passed all academic classes)
• a good discipline record
• reliable transportation to and from the work place
• a junior or senior and at least 16 years of age
• a good attitude
• good grooming habits
• secure a job by July 27, 2021

WBL Job Requirements
• WBL job placements must be either arranged or approved by the WBL Coordinator.
For a student to be placed at a family-owned worksite, the business must be recognized in the community as a legitimate enterprise which meets all of the legal requirements of operation, there must be a non-family member worksite supervisor, and the placement can’t be in a home office or private residence.
• WBL job placements must align with CTAE courses taken and/or a clearly defined career goal.
All WBL students must have taken at least one CTAE course.
• A WBL student must work a minimum of 5 hours a week for one period of WBL release, a minimum of 10 hours a week for two periods of WBL release, and a minimum of 15 hours a week for 3 periods of WBL release.
• WBL job placements must be one where the WBL Coordinator may visit.
• WBL job placements CAN NOT be through a temporary employment service.
Email *
Student First Name *
Student Last Name *
Graduation Year *
I am applying for: *
Career Goal *
Parent Phone Number
Student Phone Number
Parent Name *
Parent Place of Employment
What is your CTAE Pathway? *
Do you have any responsibilities or obligations that could interfere with your ability to commit time after school hours to this program (for example: sports, school, community activities, family, childcare, etc..) If yes, please explain below. If not, please type no. *
Are you on track for graduation? *
Do you have a job? *
If yes, what is the name of the business?
Do you plan to continue employment at this job during the next school year?
How long have you worked there?
Who is your supervisor?
What are your job duties?
Is the business owned by your family?
Do you have reliable transportation to and from work? *
Please list three teachers who are familiar with your scholastic and work performance that you would ask to recommend you for the WBL program. *
I understand (1) that enrollment in this program is limited and that making application for enrollment does not mean that I will automatically be accepted (2) that an interview with the coordinator and more paperwork may be required prior to a decision on my application (3) that once accepted, I must sign and agree to a Cooperative Training Agreement outlining my responsibilities and the program guidelines (4) that I must have a job by the first day of the semester (5) that current and previous classroom teachers will have input into my acceptance into this program (6) that my grades, attendance, and discipline record will be checked by the Coordinator prior to acceptance and may be shared with potential employers (7) that all work sites must be approved by the coordinator (8) that if a period of unemployment occurs at any time during the semester, I must inform the WBL coordinator with 24 hours and may not leave campus without permission of the coordinator or administrator (9) that class credit is based on continuous employment and completion of WBL assignments.

NON-DISCRIMINATION POLICY: It is the policy of the Bulloch County Schools to offer the opportunity to students to participate in appropriate programs and activities without regard to color, creed, national origin (Title VI of the 1972 Educational Amendments), handicap (Section 504 of the Rehabilitation Act of 1973 and PL94-142) or sex (Title II of the Educational Amendments of 1976 and PL194-482).
Signature (Type you name below) *
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