CCSD Student Internship Participation Form
Work-based Learning (WBL) is an excellent opportunity to create professional relationships and explore a career you are naturally curious about!

The information shared on this form will be used to begin the process of connecting you with an internship opportunity that aligns with your career interest.

Please be prepared to take a leadership role in securing your position for this WBL Course for Credit.

Email will be the primary mode of communication.

BEFORE SUBMITTING THIS FORM, Please ensure you have spoken with your teacher, guidance counselor, and your parents about your plans to secure and maximize an internship, which is a Work-based Learning Course for Credit.

Contact Chad Vail, CCSD Work-based Learning Partnership Coordinator - / 843-937-6489

Take a leadership role in your future with Work-based Learning!
Student First Name: *
Your answer
Student Last Name: *
Your answer
School Name: *
Your answer
Have you reviewed the 10 steps on the STUDENT WBL COURSE ENROLLMENT PROCESS and initialed each page of the Student WBL Handbook? *
The 10 steps are near the bottom of this page: The WBL Handbook will be the first document completed and turned in to your Teacher of Record for this WBL experience.
What grade are you in currently? *
What is your Date of Birth *
Some WBL Experiences have a minimum age of 18 years old.
Student Email Address: *
Email is the primary mode of communication for facilitating a Work-based Learning connection.
Your answer
Student Mobile Phone: *
Your answer
Parent / Guardian Name: *
Your answer
Home Phone: *
Your answer
Occupation / Career Interest *
If you had to say today, what would your ideal profession be?
Your answer
Which CTE courses have you completed towards being a "CTE Completer" in your high school major? *
To earn WBL course credit toward being a CTE Completer, students must have completed 3 courses in their career major, or have completed 2 and be currently enrolled in the 3rd. Course credits earned through internship experiences are otherwise awarded as elective credits.
Your answer
What would be your ideal internship experience? *
What kind of business do you see yourself being excited to work with? And, is there a specific business you have in mind? Please provide as much info as possible here to assist in connecting you with the best internship host possible.
Your answer
What is your class schedule during the time of requested internship? (or Summer Commitments?) *
Please list the classes you are enrolled to take during the semester your are requesting your WBL experience. If you are interested in a summer internship connection, please list any commitments you already have this summer, like, "I will be working with my uncle painting houses on weekends."
Your answer
Please provide specific days and times for your availability after school daily, or this summer for this internships opportunity. *
<Example Answer> "Spring semester, I am available Mon 3:30 - 6pm ; Tues through Thurs 3:45 - 6pm ; Friday - Sunday not available; during this summer, I will be available Mon - Sat, but not Sundays. I also will be out of town the week of July 4th."
Your answer
What is the ideal start & end dates for your WBL Experience? *
Please share the specific dates you believe would best fit your availability, and if Fall or Spring semester, and/or Summer are preferred. <Example Answer> "I am available from June 12 - Aug 4, except July 4 and Aug 1."
Your answer
Special Considerations *
Please list any sports teams or other extra-curricular activities that may impact your availability.
Your answer
What is your transportation plan? *
How will you get to and from your assigned position?
Your answer
What is your home address? *
Ideally, your internship location will be near your school and/or home.
Your answer
Name of recommending teacher or guidance counselor? *
Who at your school encouraged you submit this intent form?
Your answer
Some internships are paid and some are not - Are you willing to accept an unpaid internship, if offered? *
Use the "other" spot to say something like, "Unpaid only if directly aligned with my career interests."
Thank you for completing this important first step in your internship connection!
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