WBL 2021-2022 Application

NOTE: You must be a junior or senior, provide your own transportation, and have a job by the time school starts in August 2021 to remain in Work Based Learning if accepted.

Which semester are you applying for WBL? *

Fall

Spring

Required

First Name *

Actual Birthname (No Nicknames)

Last Name *

Student ID Number *

Student Email Address *

Student Cell Phone Number *

Parent/Guardian Name *

Parent/Guardian Email Address *

Parent/Guardian Cell Phone Number *

Will you be at least 16 years of age before September 1, 2021? *

Yes

Do you want Work-Based Learning scheduled during the morning or afternoon? *

How many blocks of Work-Based Learning are you requesting? *

You are required to work the same number of hours per week that you are scheduled for Work Based Learning. (Example: 1 Block = Minimum of 7.5 Hours Per Week)

Do you currently work or intern? *

Yes

If yes above, where do you currently work or intern? (Please list business name)

*Home offices cannot be accepted for Work-Based Learning.

Will you have a valid driver's license by the start of the 2021-2022 school year? *

Yes

What will be your method of daily transportation during your Work-Based Learning hours? *

What is your career goal after high school? *

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 may be required prior to a decision on my application: (3) that once accepted, I must sign additional documents outlining my responsibilities and the program guidelines: and (4) that my attendance, disciplinary, and grade records will be checked by the Coordinator prior to acceptance and may be shared with potential employers. *

Student agrees

Parent agrees and has given approval

Required

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