Personalized Placement Learning Plan
Placement: __________________________________
Date:________________
Student: ___________________________________
Placement
Supervisor: __________________________________
Related Course: ______________________________
Address: ____________________________________
Related Course Code: _____________________
Telephone: _________________________________
Co-op Credit Value: _______________________
Fax: _______________________________________
Curriculum Policy: ____________________________
E-mail: _____________________________________
Cooperative Education Teacher: _______________________________________________________________
School: ___________________________________________________________________________________
Telephone: ____________________ Fax: _______________________
E-mail: ________________________
Operation of Motor Vehicle

Student will be required to drive a motor vehicle at placement
 Company owned vehicle
 Student owned vehicle
 Please see attached Automobile
Insurance Form
Ontario Youth Apprenticeship Program

“OYAP Coop”

“Concentrated OYAP”
 SHSM  Sector:
_______________________
Apprenticeship Training Standard Reference: _____________________________________________________
Unregistered

Registration/Starting Date: _________________________
Training Consultant: ______________________ Telephone: _________________ E-Mail ______________
Ways that the student will learn at the placement…
 discussion
 practice
 coaching/mentoring
 feedback
 demonstration
 simulation
 research
 reading
 tutorial
 observation
 other:
 other:
Placement Orientation Completed: (date) ________________________________________________
Placement Supervisor Signature: _______________________________________________________________
Student Signature: _______________________________________________________________________
Halton District School Board, Halton Catholic District School Board
Page 1, 3/8/16
Name of Student: ___________________________________
Placement Demonstration of Classroom Component Expectations
Key Learnings
Demonstration of Learning at the Placement
Supervisor’s
Performance Appraisal
(see scoring scale page 3)
Indicate Level: E, G, S, N or N/A
OR Level: U, 1, 2, 3, 4 or /
Midterm
Job Readiness
Health and Safety
Rights and
Responsibilities
 applies for co-op placement (resume, covering letter, completed application
form, completed interview with employer




demonstrates safety at the placement
maintains confidentiality
shows an understanding of employee rights, responsibilities
deals appropriately with concerns at placement
Placement Demonstration of Related Course Expectations
Name of Related Course(s):
Key Learnings /
Exp Code
Demonstration of Learning at Placement (Duties)
A
B
C
D
E
Employer Expectations:
Halton District School Board, Halton Catholic District School Board
Page 2, 3/8/16
Final
Name of Student: ___________________________________
LEARNING SKILLS ASSESSMENT – Midterm & Final
**Please indicate student assessment in this chart**
Learning Skills and Work Habits
E - Excellent
Midterm
Responsibility
G - Good
Final
S - Satisfactory
N - Needs Improvement
Midterm
Organization
Final
 Fulfils responsibilities and commitments within the learning
 Devises and follows a plan and process for completing work and
environment.
 Takes responsibility for and manages own behaviour.
 Establishes priorities and manages time to complete tasks and
tasks.
achieve goals.
 Identifies, gathers, evaluates, and uses information, technology,
and resources to complete tasks.
Midterm
Independent Work
Final
 Independently monitors, assesses, and revises plans to complete
tasks and meet goals.
 Uses time appropriately to complete tasks.
 Follows instructions with minimal supervision.
Midterm
Collaboration
Final
 Accepts various roles and an equitable share of work in a group.
 Responds positively to the ideas, opinions, and traditions of
others.
 Builds healthy peer-to-peer relationships through personal and
media-assisted interactions.
 Works with others to resolve conflicts.
 Shares information, resources, and expertise, and promotes
critical thinking to solve problems and make decisions.
Initiative
Midterm
Final
Midterm
Self-Regulation
 Looks for and acts on new ideas and opportunities for learning.
 Sets own individual goals and monitors progress towards
Demonstrates the capacity for innovation and a willingness to take
risks.
 Seeks clarification or assistance when needed.
 Assesses and reflects critically on own strengths, needs, and
 Demonstrates curiosity and interest in learning.
 Approaches new tasks with a positive attitude.
 Recognizes and advocates appropriately for the rights of self and
others.
achieving them.
interests.
 Identifies learning opportunities, choices, and strategies to meet
personal needs and achieve goals.
 Perseveres and makes an effort when responding to challenges.
Midterm Assessment
**Please make sure you assess the Learning Skills in chart above**
Midterm Assessment - Supervisor’s Comments
Strengths:
Areas for Improvement:
Supervisor’s Signature:
Final
Date:
Halton District School Board, Halton Catholic District School Board
Page 3, 3/8/16
Name of Student: ___________________________________
Midterm Assessment – Student’s Comments
Student’s Signature:
Date:
Final Assessment
**Please make sure you assess the Learning Skills in chart on page 3**
Final Assessment - Supervisor’s Comments
Strengths:
Areas for Improvement:
Supervisor’s Signature:
Date:
Final Assessment – Student’s Comments
Student’s Signature:
Date:
Halton District School Board, Halton Catholic District School Board
Page 4, 3/8/16