PARENT/GUARDIAN - Work-Based Learning Internship Agreement

PARENT/GUARDIAN - Work-Based Learning Internship Agreement

This form should be completed by the student's parent/guardian. Please note: There are separate forms that the student AND the employer/internship supervisor must complete.
Parent/Guardian Name*

First NameLast Name
Student Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Parent Phone Number (include area code)*

Area CodePhone Number
Additional Emergency Contact*

First NameLast Name
Emergency Contact Phone Number (include area code)*

Area CodePhone Number
Worksite Name/Location*

WorksiteLocation

General Requirements
CREDIT: The following MUST OCCUR for the student to receive credit for the work-based learning experience:
- Student works a minimum of 120 total hours per semester to receive a Carnegie course credit or 40 hours to receive state accountability credit.
- The student turns in all time sheets and other paperwork on time.
- The employer completes evaluations each grading period (two per semester).
PROVISIONS FOR TERMINATION: This agreement may be terminated for any of the following reasons:
- Non-performance on part of student and/or employer.
- Relocation of student and/or employer.
- Change in student’s career choice.
- Other reasons such as conviction of a crime, non-attendance of school and/or work, not calling employer as far in advance as possible prior to work absence, or other reasons deemed appropriate by the administration and/or employer.o student resigning from internship.
I understand that my child is responsible for providing transportation for himself/herself/themselves to his/her/their internship location. I give permission for my child to participate in and transport himself/herself/themselves to the jobsite for the Work-Based Learning program.

Yes. My child will be driving himself/herself/themselves to and from his/her/their internship location during the school. I give permission for my child to leave campus to travel to the jobsite for the WBL program.My child requires no transportation because his/her/their internship is located within the school building at ATC or the high school (RHHS/NHS/SPHS).No. My child DOES NOT have permission to transport himself/herself/themselves to his/her/their internship location and I do not wish for him/her to participate in the WBL program at ATC or the high school (RHHS/NHS/SPHS).I give permission for my child to use an approved transportation service that is safe and reliable to meet the needs of my child getting to and from school and/or jobsite. I have discussed this option with the course instructor, WBL Facilitator, and/or Director/Assistant Director of my child's program.Other
Responsibilities
THE STUDENT WILL:
- Be at least 16 years old and at least Sophomore status.
- Be responsible for their own transportation.
- Maintain regular attendance at the work-site.
- Maintain good grades, attendance and discipline at school.
- Communicate openly with the WBL Coordinator if conditions interfere with progress at school.
- Notify WBL Coordinator prior to resigning from internship position.
- Turn in all paperwork, including training agreement, time sheets and evaluations, on time.
- Attend all required WBL meetings.
- Understand that quitting will result in being dropped from the WBL program and a grade of withdrawal failing (WF) or failing (F).
- Understand that being fired will result in being dropped from the WBL program and a grade of F.
THE EMPLOYER WILL:
- Appoint a training supervisor for the student and facilitate the training.
- If internship is paid, pay the student at least current minimum wage, sign student’s time reports and conform with all local, state and federal laws.
- Assess the student’s progress via regular evaluations quarterly on forms provided by WBL Coordinator and provide the student with a variety of experiences.
- Permit a school representative to visit the supervisor and student at the work site.
- Notify the WBL Coordinator promptly with conditions or concerns regarding progress of the student, or upon termination.
- Refrain from working student over 20 hours per week.
THE SCHOOL DISTRICT WILL:
- Appoint a coordinator to assist the student and employer and provide guidance.
- Monitor student progress at the training site.
- Adjust class schedules where possible to accommodate the student/employer.
- Provide Worker's Compensation Insurance.
THE PARENT WILL:
- Notify the WBL Coordinator Immediately with conditions that are interfering with the student’s progress at school.
- Notify the WBL Coordinator prior to student resigning from internship.
*Rock Hill School District Three does not discriminate on the basis of race, color, creed, national origin, sex, sexual orientation, religion, age, disability or other legally protected status in admission to, access to, or operations of its programs, services or activities. It does not discriminate in its hiring or employment practices.
I have read and agree to terms and conditions listed above.
Parent/Guardian Signature. Please sign below indicating that you agree to adhere to the conditions listed above.*

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PARENT/GUARDIAN - Work-Based Learning Internship Agreement

General Requirements

Responsibilities