Work-Based Learning Provider Startup Survey

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for participating in Wethersfield High School's Unpaid Work-Based Learning Experience program. Please fill out this survey to help us establish this partnership.

Email *

First Name *

Last Name *

Business Name *

How will the student experience this opportunity? *

In-person

Virtually

Hybrid or in-person and virtual

Other:

Name of the person who will supervise the student intern *

Supervisor email address *

Supervisor phone number

Do you have a human resources department that will work with the intern during the onboarding process and throughout the internship? *

Yes

If you have an HR representative who will work with our Work-Based Learning Coordinators, please share that person's name, email address, and phone number here.

Please provide a JOB DESCRIPTION for your student learner ( List tasks, responsibilities, projects, etc.) *

When would you like the Work-Based Learning experience to begin? If you don't have a specific start date in mind, please give a general idea of the timeframe. *

Fall Semester (October)

Spring Semester (March)

Both Fall and Spring Semesters

Students need to obtain 60 hours in order to meet the minimum required for the Internship class. Are you able to provide at least 4-5 hours per week of unpaid learning experiences? *

Yes

Will the student need to attend a New Employee Orientation?

Yes

Maybe

Clear selection

If you require an orientation, will that session take place during the school day requiring the intern to miss a class?

Yes

Maybe

Clear selection

Please list employment documentation student needs to bring to an orientation or on his/her first day of Internship. *

Please list any specific dress code requirements for this student. *

Please share the policy for cell phone use in your workplace. *

The Internship Coordinator will attempt at least one worksite visit. Is there any specific protocol he/she needs to follow for this? If so, please describe what needs to be done. *

Is the Internship Coordinator allowed to take pictures of the student on the job and use them on social media or?

Option 1

Clear selection

If there are restrictions on photography, please explain the procedure here. *

How will you educate your student learner about any Covid-19 protocols/precautions you might have in place? *

How will you educate your student learner about any Covid-19 protocols/precautions you might have in place?

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Wethersfield Public Schools.

Does this form look suspicious? Report

Forms