Forsyth County Schools
2016 - 2017
Work-Based Learning (WBL) opportunities are structured experiences that connect the student’s career goal and
classroom learning with a productive work environment. Work-Based Learning provides students with opportunities for
instruction in occupational skills and career exploration, and guidance in identifying employment and educational goals.
Students have the opportunity to connect what they learn in school with work site application.
Admission Requirements














A defined career goal
16 years or older
Valid picture ID
A junior or a senior in good standing with the school system
Career, Technical, and Agriculture Education (CTAE) or academic, fine arts, or world language coursework
related to a career goal and job placement
Dependable transportation
On track for graduation
Good attendance and discipline record
Willing to submit to all health related screenings required by the sponsoring employer (ex. pre-employment
drug screenings, etc.)
Program Expectations
Exhibit professionalism at the approved work site.
Work 5 hours/week for each period released from school. I.e., if you are released 2 periods, you must work at
least 10 hours.
Provide wages/hours documentation. If in an unpaid position, provide monthly hours log.
Submit monthly assignments tied to workplace competencies and attend meetings with coordinator as
scheduled.
Participate in spring Mock Interviews.
Application Packet Directions



Complete and turn in the attached application by April 1 to the counseling office or the WBL Coordinator.
All information should be neat, accurate and readable.
Incomplete applications will not be processed.
NON-DISCRIMINATION POLICY: It is the policy of Forsyth 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) or sex (Title II of the Educational Amendments of 1976 and PL194-482).
Work-Based Learning Application
2016 - 2017
Student Full Name _______________________________ Career Pathway ___________________
Grade ______
Student Email ________________________________________________ Student Cell # ________________________
Parent/Guardian Name _____________________________________________Cell # _____________________________
Parent E-mail _______________________________________________________________________________________
List pathway coursework that you have completed or are currently taking:
1.____________________________________________ 2. ______________________________________________
What is your career goal? _____________________________________________________________________________
Are you currently working? Yes No If so, where? ________________________________________________________
Business address _______________________________________________________ Hours worked per week? _______
What does this business do? _________________________ What are your duties? ______________________________
Supervisor’s First and Last Name ______________________________________ Phone # ____________________
If this job is in your career area of interest, do you want to use it as your WBL placement?
Yes
No
Do you have reliable transportation and can travel to a work location(s)?
Yes
No
Have you ever left a job without giving two weeks’ notice? Yes No If yes, why? ______________________________
Do you have any responsibilities or obligations after normal school hours that could interfere with your work
commitment? (for example: sports, school or community activities, part-time job, family/childcare)? Yes No
If yes, please describe:_________________________________________________________________________
NON-DISCRIMINATION POLICY: It is the policy of Forsyth 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) or sex (Title II of the Educational Amendments of 1976 and PL194-482).
Other Application Requirements
Writing Sample and Other Required Information

Attach:
1. a typed 1-2 paragraph essay to this application that describes how your career objectives, previous work
experience, and special skills would benefit a company that may choose to hire you as a result of
participation in this Work-Based Learning program. In addition, describe the benefits that you expect to
gain for yourself, if selected. Please write carefully and legibly.
2. an unofficial copy of your transcript (print from portal account).
3. recommendation forms (attached) from 2 teachers who could provide a reference for you. One must be
your CTAE or pathway instructor; the other may be a teacher of your choice.
Work Based Learning Application Certification



I qualify for application to the Work Based Learning program based on state admission requirements.
I certify that the facts contained in this application are true and complete to the best of my knowledge, and
understand that, if selected for a work-based learning program, falsified statements may be grounds for
removal. I authorize investigation of all statements contained herein, the references listed in this application, all
information concerning previous employers, and release all parties from liability for any damage that may result
from furnishing the same to the WBL school coordinator.
If I am accepted into the work-based learning program, I will
o commit to participate for the entire school year.
o attend scheduled meetings and submit monthly work on time.
o take advantage of every opportunity to improve my skills and efficiency in the classroom and the world
of work.
___________________________________________
Student Signature
_______________________________________
Date
I give my child permission to apply for the Work-Based Learning program.
______________________________________________
Parent/Guardian Signature
_______________________________________
Date
NON-DISCRIMINATION POLICY: It is the policy of Forsyth 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) or sex (Title II of the Educational Amendments of 1976 and PL194-482).
Work Based Learning Application- Teacher Evaluation 1
Student: _____________________________________ Teacher: ____________________________________ WBL Coordinator: Ann Williams
Applicants: Please ask your references to complete these forms and place them in my box or send them to me via campus mail.
Notice to Teacher Reference: Thank you for taking the time to complete this information. You input will be used to decide whether or not this applicant would be a good candidate
for Work Based Learning/ Youth Apprenticeship. Mark the box of the appropriate ranking. Please be honest and use specific examples where applicable. All information will be
completely confidential - please DO NOT give this form back to the student. You may place it in the Coordinator’s box or send it via campus mail. If you have any additional
information that you would like to share with the coordinator personally, please don't hesitate to call or email.
DUE DATE: No later than April 1, 2015
Criteria
Point Value
5
4
Comments
3
2
1
Work Quality
Very accurate &
thorough
Careful; rarely
inaccurate
Usually accurate
Careless
Makes many errors
Time Management
Very busy
Busy
Average
Needs improvement
Wastes time
Initiative
Self-motivated
Needs little direction
Performs as
instructed
Not a self-starter
Must be told what to
do
Efficient &
enthusiastic; sought
by others
Complete, concise,
correct, concrete
Very cooperative &
friendly; very eager
to learn
Above average;
works well with
others
Clear; very few
errors
Cooperative &
friendly; enjoys
work
Average
Has problems with
others
Unproductive
Average
Some inaccuracies
Vague; incorrect
Cooperative;
average interest in
work
Negative attitude;
little interest in job
Unable to get along;
does not like work/
job
Always trustworthy;
Adheres to
policy/rules
Almost always
trustworthy; Almost
always adheres to
policy/rules
Sometimes
trustworthy;
Sometimes adheres
to policy/rules
Occasionally
trustworthy;
Occasionally
adheres to
policy/rules
Dishonest; Refusal
to policy/rules
Accepts willingly
Accepts
Needs improvement
Unsatisfactory
Seldom off
Absent occasionally
Most often good
Occasionally poor
Teamwork
Effective
Communication
Attitude/
enthusiasm
Honesty/Integrity
Responsibility
Dependability/
Punctuality
Dress & Grooming
Accepts readily/
handles well
Always prompt/
present
Always clean and
appropriate
Above average
absences
Often poor/
inappropriate
Excessive absences
Always
inappropriate
50 Points Possible
Do you feel this student should be admitted into the WBL/YAP Program?
□Yes □No
___________ Points Earned
………………………………………………………………………………………………………………………
Teacher Signature
Date
Work Based Learning Application- Teacher Evaluation 2
Student: _____________________________________ Teacher: ____________________________________ WBL Coordinator: Ann Williams
Applicants: Please ask your references to complete these forms and place them in my box or send them to me via campus mail.
Notice to Teacher Reference: Thank you for taking the time to complete this information. You input will be used to decide whether or not this applicant would be a good candidate
for Work Based Learning/ Youth Apprenticeship. Mark the box of the appropriate ranking. Please be honest and use specific examples where applicable. All information will be
completely confidential - please DO NOT give this form back to the student. You may place it in the Coordinator’s box or send it via campus mail. If you have any additional
information that you would like to share with the coordinator personally, please don't hesitate to call or email.
DUE DATE: No later than April 1, 2015
Criteria
Point Value
5
4
Comments
3
2
1
Work Quality
Very accurate &
thorough
Careful; rarely
inaccurate
Usually accurate
Careless
Makes many errors
Time Management
Very busy
Busy
Average
Needs improvement
Wastes time
Initiative
Self-motivated
Needs little direction
Performs as
instructed
Not a self-starter
Must be told what to
do
Efficient &
enthusiastic; sought
by others
Complete, concise,
correct, concrete
Very cooperative &
friendly; very eager
to learn
Above average;
works well with
others
Clear; very few
errors
Cooperative &
friendly; enjoys
work
Average
Has problems with
others
Unproductive
Average
Some inaccuracies
Vague; incorrect
Cooperative;
average interest in
work
Negative attitude;
little interest in job
Unable to get along;
does not like work/
job
Always trustworthy;
Adheres to
policy/rules
Almost always
trustworthy; Almost
always adheres to
policy/rules
Sometimes
trustworthy;
Sometimes adheres
to policy/rules
Occasionally
trustworthy;
Occasionally
adheres to
policy/rules
Dishonest; Refusal
to policy/rules
Accepts willingly
Accepts
Needs improvement
Unsatisfactory
Seldom off
Absent occasionally
Most often good
Occasionally poor
Teamwork
Effective
Communication
Attitude/
enthusiasm
Honesty/Integrity
Responsibility
Dependability/
Punctuality
Dress & Grooming
Accepts readily/
handles well
Always prompt/
present
Always clean and
appropriate
Above average
absences
Often poor/
inappropriate
Excessive absences
Always
inappropriate
50 Points Possible
Do you feel this student should be admitted into the WBL/YAP Program?
□Yes □No
___________ Points Earned
………………………………………………………………………………………………………………………
Teacher Signature
Date