7

					Work-Based
 Learning
  Guide

2011-2012
                                         TABLE OF CONTENTS
        Glossary of Terms .................................................................................................. 3-4
   I.   Introduction .............................................................................................................. 5
  II.   Eligibility ................................................................................................................ 6-7
 III.   Policy and Procedures ............................................................................................ 12
 IV.    a) Training Agreement ............................................................................................ 15
        b) Transition Statement of Understanding .............................................................. 18
  V.    State and Federal Standards .................................................................................. 19
 VI.    Safety Training Plan/ Record & Progress Report ..................................................... 21
 VII.   Insurance and Emergency Information ................................................................... 26
VIII.   Transportation ... ..................................................................................................... 28
 IX.    Nine Weeks Evaluation .......................................................................................... 30
  X.    Time/Earnings Record ............................................................................................ 32
 XI.    End of the Year Evaluations ................................................................................... 37
 XII.   Information for Co-Op Employers ........................................................................... 41
XIII.   Information for Transition Employers..........................................................................42
XIV.    Students in Occupations Deemed “Hazardous” ...................................................... 44
XV.     Sample Safety Tests...............................................................................................46-47
XVI.    Frequently Asked Questions ................................................................................... 45

    WBL Forms:
    Work Based Learning Application .............................................................................. 8-9
    Policies & Procedures ................................................................................................ 12
    WBL Student Support Plan ......................................................................................... 13
    Academic Cooperative Education Statement of Understanding .................................. 14
    WBL Training Agreement ........................................................................................... 16
    Transition Statement of Understanding ...................................................................... 18
    Safety Training Plan/Record .................................................................................. 23-24
    Progress Report ......................................................................................................... 25
    WBL Insurance & Emergency Information .................................................................. 27
    Transportation ............................................................................................................ 29
    WBL Coordinator Travel Log & Mileage Reimbursement............................................ 31
    Time Wage Record 1st thru 4th nine week period ................................................... 33-36
    Student Evaluation of WBL ......................................................................................... 38
    Employer/Supervisor Evaluation of WBL .................................................................... 39
    Hazardous Occupation Agreement ............................................................................. 45
    Safety Tests .......................................................................................................... 46-47

                     The State Work Based Learning Handbook can be fount at:
                            http://www.tennessee.gov/education/cte/wb/
                    Information on Legal issues regarding WBL can be found at:
                        http://www.tennessee.gov/education/cte/wb/doc/legal
                            Williamson County Schools - Career and Technical Education
                                   1320 West Main, Suite 202, Franklin, TN 3704
                                                 615-472-4067
                                   WORK BASED LEARNING GLOSSARY OF TERMS

ATTENDANCE
Students must have no more than 5 (five) unexcused absences per the truancy laws of the State of Tennessee while
participating in the WBL program. Students not meeting this standard at the end of the first semester will not be permitted to
continue in the program during the second semester.

COOPERATIVE EDUCATION
Cooperative education is a structured method of instruction whereby students coordinate their studies with a paid job in a field
related to their academic or vocational course. Instruction is based on written training and evaluation plans agreed to by the
school and employer. The students receive credit for both classroom and work experiences related to the course of study. Credit
hours and intensity of placements often vary with the course of study.

FIELD TRIPS
Field trips to the work-site involve classes or small groups of students visiting appropriate work-sites during elementary and
middle school years. These activities are supervised and designed to explore a variety of jobs. High school students spend time
at job sites interviewing employers and employees as part of an assigned class project.

FULL TIME EQUIVALENT (FTE)

INDUSTRY in the CLASSROOM
Industry in the classroom is an instructional strategy in the elementary or middle school years when business representatives
visit students in the classroom to share information about their jobs. In the high school years, employers and employees may
share information about jobs through career fairs.

INTERNSHIP (for students)
Student internships are situations where students work for an employer for a specified period of time to learn about a particular
industry or occupation. Non-paid experiences are limited to nine weeks. Students' work-based activities may include special
projects, a sample of tasks from different jobs, or tasks from a single occupation. Internships may include community service
(service learning) placements if they meet the above requirements and are related to the student's program of study/career
major.

JOB SHADOWING
Job shadowing is typically a part of career exploration activities in late middle and early high school grades. A student follows an
employee at a business for one or more days to learn about a particular occupation or industry. Job shadowing can help
students explore a range of career objectives and select a career major for the latter part of high school.

LOCAL EDUCATION AGENCY (LEA)

METHOD
Is a manner, means, or procedure; a systematic and regular way of accomplishing a given task.

OUT-OF-SCHOOL EXPERIENCES
Academic/instructional activities that enhance the development of students' abilities and must generate a final product; i.e.:
advanced music lessons, foreign language.

PROGRAM OF STUDY
A series of courses closely related under the same curricular umbrella. Example of courses of study is:
Marketing - Marketing I, Entrepreneurship, Marketing II, International Marketing;

RELATED CLASS
A specific class (course) approved by the State Board of Education in which the student is concurrently enrolled and in which the
student is earning additional credit through the WBL method. The IEP/transition plan will determine the related Special Education
class and appropriate placement for a student with a disability. (Examples: Resource Class or CDC Class).

SCHOOL-SPONSORED ENTERPRISES
A school-sponsored enterprise is an experience in which students as part of their school program produce goods and services.
School-sponsored enterprises typically involve students in the management of a project that may involve the sale of goods for
use by others. They normally involve students in all aspects of the business to the extent practicable. They may be conducted on
or off the school site but must be a part of the student's regular school program.




                                                               3
SELECTED STUDENTS
Students who show a desire to learn the skills needed to succeed in a career of their choice and those students who can be
placed in jobs that will help them attain their career goals should be selected to participate.

SERVICE LEARNING
Service learning is an instructional method that combines community service with a structured school-based opportunity for
reflection about that service, emphasizing the connections between service experiences and academic learning. Although most
service learning activities vary by educational purpose, most programs balance students' need to learn with recipients' need for
service. Students benefit by acquiring skills and knowledge, realizing personal satisfaction and learning civic responsibility, while
the community benefits by having a local need addressed.

STUDENT LEARNER
A student enrolled in a course of study and training in a program under the recognized state and local educational authority and
who is employed on a part-time basis, in accordance with, or pursuant to the aforementioned education program.

STUDENT WORKER
A student who is simply working part-time or who is employed part-time under one of many arrangements, but who is not in the
WBL phase of an education program. (Note: there is a legal distinction between a student learner and a student worker).

TENNESSEE DEPARTMENT OF EDUCATION (TDOE)

TENNESSEE DEPARTMENT OF LABOR & WORKFORCE DEVELOPMENT (TDOL&WD)

TRAINING AGREEMENTS
The law requires that a training agreement be completed and filed. A training agreement states the conditions and parameters of
employment which participants agree to when taking part in a training program. A training agreement is not a training plan.

TRAINING PLAN
A training plan is an outline of the competencies to be developed on the job. Training plans list suggested activities. These
learning activities are designed to give the student an opportunity to apply principles learned in the classroom to on-the-job
experiences. When appropriate, training plans may include suggested activities to be learned through student organization
activities and classroom experiences. A training plan states the specific learning, which will lead to the student's career goal. A
training plan must include a record of safety training.

TRAINING STATIONS or WORK SITES
Businesses that provide on-the-job training experiences for students are called training stations. Training stations should be
selected after the WBL coordinator has visited the potential training sites and determined that they would provide meaningful and
safe learning experiences. Once selected, employers should be given the opportunity to interview and hire the students of their
choice. However, WBL students cannot be hired if it causes the displacement of a training station's regular worker. At each
training station, a specific training sponsor/mentor is to be designated. This person will be directly responsible for supervising the
student while he/she is on the job.

TRANSITION WBL ACTIVITIES
Transition WBL activities are designed to facilitate community based instruction, employment experiences and socialization skills
for the student with disabilities. The transition WBL method includes both paid and non-paid training activities for both credit
and/or completion of the IEP goals and objectives.
(Students accessing WBL through transition option, and does not include students labeled as gifted or students with
IEPs accessing WBL through general education WBL options. Anything not related to this MUST be approved through
Central Office first.)

UNITED STATES DEPARTMENT OF EDUCATION (USDOE)

UNITED STATES DEPARTMENT OF LABOR (USDOL)

WORK BASED LEARNING (WBL)
WBL activities are part of a structured system, for all students, at the high school level that allow students to apply classroom
theories and to explore career options at the work site or connect classroom learning to work.

WORK BASED LEARNING COORDINATOR
WBL coordinators are educators who are trained and endorsed to coordinate school-based and work-based experiences for
students.




                                                                4
                                          I. INTRODUCTION
Cooperative Education is designed to benefit students by providing them with opportunities to gain skills and
knowledge through on-the-job experience and training in an area related to an advanced or culminating
course in which the student is enrolled. WBL is available to students in both the university and technical paths,
and it is made possible by employers, not for profit agencies and schools entering into partnerships and
training agreements. Representatives of the school and the employer will work together to design a training
plan for each co-op student.

Job shadowing is typically a part of career exploration activities in late middle and early high school grades.
A student follows an employee at a business for one or more days to learn about a particular occupation or
industry. Job shadowing can help students explore a range of career objectives and select a career major for
the latter part of high school.

Service learning is an instructional method that combines community service with a structured school-based
opportunity for reflection about that service, emphasizing the connections between service experiences and
academic learning. Although most service learning activities vary by educational purpose, most programs
balance students' need to learn with recipients' need for service. Students benefit by acquiring skills and
knowledge, realizing personal satisfaction and learning civic responsibility, while the community benefits by
having a local need addressed.

Transition (paid) and (nonpaid/training) is an opportunity for students with IEPs who experience moderate to
severe disabilities to gain skills through community-based instruction, employment experiences and
socialization opportunities. Participation in WBL must be related to each student’s measurable post secondary
goals and documented in the transition plan of the IEP. The transition plan of the IEP will determine the
appropriate job-related instruction for each student.
(Students accessing WBL through transition option, and does not include students labeled as gifted
or students with IEPs accessing WBL through general education WBL options.)

WBL activities are part of a structured system, for all students, at the high school level that allow students to
apply classroom theories and to explore career options at the work site or connect classroom learning to work.

This information is intended to be a guide to the WBL Program in the Williamson County School System. The
information can be used by students, teachers, counselors, parents, and employers as a guide to the WBL
experience. The student is expected to be familiar with the guide and to discuss the content with his or her
parents and teachers.

If there are any questions concerning the WBL Program, or the contents of this guide, please contact the WCS
Coordinator for Career and Technical Education.
      Typically the marketing teacher at each school serves as the WBL Coordinator for students who co-op
         through the marketing class.
      The marketing teacher may also serve as the WBL coordinator for other career and technical
         programs in a school.
      The school may have additional WBL coordinators who work with career and technical programs other
         than marketing.
      The school may have an academic WBL coordinator who works with students who co-op through
         academic courses.
      The school may have a teacher who serves as the WBL coordinator for transition students.
      If the school offers health sciences, the health science teacher may be trained as a WBL coordinator.
         Students cannot be placed in health care work-sites unless they are enrolled in health science and are
         supervised by a health science teacher who has been trained as a WBL Coordinator.
      A system-wide trade and industrial education WBL coordinator serves as the coordinator for career
         and technical students in all programs trade and industrial. These programs include, but are not
         limited to: Automotive Technology Drafting, Criminal Justice, Culinary Arts, Graphic Communications,
         Construction Technology, and Media Production. To identify a system-wide WBL Coordinator, contact
         the district coordinator for CTE at 472-4067.
      There may also be a system wide WBL coordinator for health science; another for academic co-op;
         another for a mixture of CTE students in such programs as marketing and business technology,
         agricultural education, family and consumer science, technology engineering education.
                                                      5
                                           II. ELIGIBILITY

In order to participate in the WBL program, students must meet the following requirements:


Standards
    Be a senior or have special approval of the appropriate Work-Based Learning Coordinator (See
      page 1 for description of various coordinators).
    Be enrolled in an advanced or culminating course related to career interest concurrently with the
      WBL experience.
    Have passed all related EOC’s (state exam) or be participating in a program leading to passing
      the required examination(s).
    Have a satisfactory record of grades, attendance, and behavior.
    Students must have no more than 5 (five) unexcused absences per the truancy laws of the State
      of Tennessee while participating in the WBL program. Students not meeting this standard at the
      end of the first semester will not be permitted to continue in the program during the second
      semester.
    For students eligible for special education, more stringent eligibility requirements shall not go
      beyond state and/or federal regulations that pertain to special education programs and services.
      The transition service plan of the IEP will be the determining factor which may include the
      minimum standards.


Registration
    In order to participate in a WBL experience (co-op or service learning), students, including those
       with IEPs (even those labeled as gifted) and those accessing WBL through CTE or academic,
       must obtain a WBL application from the school counseling center or WBL Coordinator. This
       application must be presented to the school counselor upon registering for classes. The school
       counselors will forward the application to the appropriate WBL Coordinator (page 8-9).
    Students with moderate and severe disabilities who access WBL through the transition plan of
       the IEP must be in compliance with their IEPs and do not need to complete an application.


Transportation
    Have reliable transportation to the training agency (job site).


Approval Process
    Have parent consent to participate in the program
    Have the principal’s approval
    Be placed in an appropriate setting to perform non-paid service or employed in a job that is
      related directly to course in which the student is earning the additional credit for the WBL
      experience. The placement must be approved by the appropriate Work-Based Learning
      Coordinator
    Complete all related paperwork and submit it to the Work-Based Learning or Service Learning
      Coordinator
    Read and sign and have parent/guardian read and sign WBL policies




                                                  6
Applications and Forms that must be signed and submitted to the school Work-Based Learning
or Service Learning Coordinator
(For students receiving WBL as part of their transition plans, a copy of all forms must also be submitted
to Student Support Services.)

      Training Agreement
      Training Plan/Progress Report/Safety Training Record
      Insurance and Emergency Information
      Transportation Note: The student must provide a copy of the certificate of insurance for the
       vehicle being used by the student (This does not mean a copy of the insurance card). A copy of
       the student’s driver license is required also.
      Proof of safety training
      Employer/Supervisor Evaluations
      Schedule of hours
      Time/Wage Reports




                                                   7
Work Based Learning Application                                                                                                                                   Date____________

Check the type of Work Based Learning:
□ Academic      (Math, Science, English, World Geography, etc)                 □ Health Science                (Clinical or Co-op)        □Service Learning □Transition (SSS)
□CTE  (agriculture, business, construction, criminal justice, culinary arts, drafting, family & consumer sci, early childhood ed, info tech, jtg, marketing, media pro, tech engineering, visual com)



Name__________________________________________________                                                                                        Home Phone_______________________

Address________________________________________________                                                                                       Cell Phone                  _______________________

         ________________________________________________                                                                                    Birth date_________________________

E-Mail Address__________________________________________                                                                                      Age______________


In the boxes below, list the classes you have taken your junior year and plan to take your senior year and the final
grade earned in each class.
Note: A copy of your transcript must be attached as part of this application.
                         Junior Year                                              Senior Year
 Class Name                             Grade Earned           Class Name                             Grade Earned
 1._____________________________________________ 1._____________________________________________

 2._____________________________________________                                                                          2._____________________________________________

 3._____________________________________________                                                                          3._____________________________________________

 4._____________________________________________                                                                          4._____________________________________________

 5._____________________________________________                                                                          5._____________________________________________

 6._____________________________________________                                                                          6._____________________________________________


Current GPA: ________                           Did you miss over 6 full days of school last semester?                                                                                  Last year?

Have you been enrolled in ALC or suspended? ______

If so, when and for what offense? _____________________________

Are you currently working?                                                                                       If so, where?

Do you plan to work this summer?                                                                               In what type of job?

List previous jobs you have had:

1. Business name: _________________________ Job Title: _________________________How long? _______

   Reason for leaving__________________________________________________________________________

2. Business name: _________________________ Job Title: __________________________How long? _______

   Reason for leaving: _________________________________________________________________________

Do you have a Driver’s License? ___________

What kind of transportation will you have to and from your job/service site? ________________________________

What activities are you currently involved in (in school and out of school)?_________________________________
_______________________________________________________________________ (Continue on back)
                                                          8
What activities do you plan to participate in next year? ________________________________________________

____________________________________________________________________________


What are your future educational and/or career goals?_________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________


Explain why you would like to be in the WBL program or Service Learning: ______________________________

____________________________________________________________________________________________


Do you need this course to graduate?


List three teacher references:

1.

2.                                                                                  Who is your School Counselor?

3.

WBL Related Teacher Signature:


                                                            Please read and sign below:

I understand that students must meet the requirements, as stated in the WCS work-based learning guidelines, WCS
Board Policy 4.2093, Program of Studies, regarding attendance, grades, and behavior, in order to be accepted into
the Co-op Program.

Student Signature:                                                                                            Date:

Parent/Guardian Signature:                                                                                    Date:



                       Return to:                                                                     to schedule an interview.

            The WBL Program offers equal opportunity to all qualified applicants without regard to race, sex, color, religion, national origin, or disability.




Turn in this application when you register to your guidance counselor.

The following must be completed prior to enrolling in WBL:
    Copy of your transcript (attached)
    Application with the above three signatures
    Register for an academic or CTE course that relates to your career interest
    Have a job in mind that relates to the academic/CTE course that you plan to take while
       enrolled as a WBL Student



                                                                                9
            WBL Guidelines for Students in the Alternative Learning Center (ALC):

If a student has been assigned to ALC at the beginning of a school term or is continuing his/her
assignment to ALC from the previous school term or has been assigned to ALC with the 10 day drop/add
period, the student will not be allowed to participate in WBL during the school term.

If the school term has progressed beyond the 10 day drop/add period and a student has a new
assignment to ALC, the student will not be allowed to participate in WBL by leaving ALC one-two hours
early. The student shall work/volunteer after school hours only and continue to document their required
WBL hours to earn school credit. The WBL coordinator will send related work or extended reading
assignments to the ALC for the student to complete that relates to work ethic, character development,
safety in the workplace, or other topics related to the student’s WBL training plan. At the end of that
semester the student will be removed from WBL.

If the student is receiving support services, he/she is not treated any differently.

If a child’s four-year-plan uses co-op as meeting the fourth credit required for the technical path for
graduation and no substitute course is available to meet the same requirement, a discussion will take
place and a plan will be made for the student to ensure that the student will still be able to graduate. If
this plan should include an exception to allow the student to continue in co-op, the student shall
work/volunteer after school hours only while continuing to document their required WBL hours to earn
school credit. The WBL coordinator will send related work or extended reading assignments to the ALC
for the student to complete that relates to work ethic, character development, safety in the workplace, or
other topics related to the student’s WBL training plan.




                                                    10
                    WBL Guidelines for Homebound Students

If a student has been assigned to homebound instruction at the beginning of the school year or is
continuing his/her assignment of homebound status from the previous school year or has been assigned
to homebound instruction within the 10 day drop/add period, the student will not be allowed to participate
in WBL during the school year.

If the school year has progressed beyond the 10 day drop/add period and a student has a medical
referral for homebound instruction, the student will not be allowed to participate in WBL by leaving home
to work. The WBL coordinator will send related work or extended reading assignments to the
homebound student for him/her to complete that relates to work ethic, character development, safety in
the workplace, or other topics related to the student’s WBL training plan. If the student is in his/her first
semester of WBL, at the end of the semester the student will be removed from WBL.

If a child’s four-year-plan uses co-op as meeting the fourth credit required for the technical path for
graduation and no substitute course is available to meet the same requirement, a discussion will take
place and a plan will be made for the student to ensure that the student will still be able to graduate. The
WBL coordinator will send related work or extended reading assignments to the homebound student for
him/her to complete that relates to work ethic, character development, safety in the workplace, or other
topics related to the student’s WBL training plan.




                                                    11
                    Ill.     POLICIES AND PROCEDURES
Standards
     All local, State and Federal standards and guidelines for work-based learning programs will be
      followed. See page 20 for State and Federal Standards.

Maintaining a positive WBL Experience
     WBL students will be required to maintain a record of their volunteer hours or hours worked and
      earnings. Forms for this purpose will be provided by and kept by the Work-Based Learning
      Coordinator; this record must be updated weekly by the student. (See pages 34-37).
     Since the student’s job or placement is an extension of the school day, the student must not quit
      the job without prior approval of the Work-Based Learning or Service Learning Coordinator.
     In order to continue in the WBL program, students must pass all courses each grading period. If a
      student receives a progress report that indicates a failing course, the WBL Coordinator will
      develop a plan of support in conjunction with the teacher of the failing course and with the
      employer/supervisor. This plan may include limitation of daily WBL release time in order to
      provide the necessary support to the student. This WBL Student Support Plan must be approved
      by the principal (see page 13). If, at the end of the semester, the student fails any course, he/she
      will be removed from the program for the remainder of the school year.
     Co-op students will be employed during school hours for a portion of his/her work period.
      Saturday and Sunday hours alone do not qualify for credit.
     For students accessing WBL through their transition plans of their IEPs, continuance of their WBL
      experiences will be defined by their WBL IEP goals in their transition plans.
     At all times the student’s continued WBL participation depends upon the recommendation of the
      teacher of the related class, the Work-Based Learning Coordinator, the Principal, IEP team,
      and/or other administrative personnel.

Attendance
     Students must have no more than 5 (five) unexcused absences per the truancy laws of the State
      of Tennessee while participating in the WBL program. Students not meeting this standard at the
      end of the first semester will not be permitted to continue in the program during the second
      semester.
     Absences from the job (other than illness) will be considered a violation of the WBL regulations.
      Students wishing to participate in study trips or other school activities during normal work hours
      must make arrangements in advance with the employer/supervisor. Students absent from school,
      other than for a doctor’s or dental appointment, may not go to the WBL job site.

  Note:      If students are removed from the WBL program, they will be assigned to a study hall or
             class and will not be allowed to continue to leave school early.


  I have read, understand, and agree to abide by the policies stated above.



  WBL Applicant                                                   Date


  I have read, and understand the policies above. I agree for my child to participate in the co-
  op program.


  Parent/Guardian                                                 Date

                                                 12
                           WBL Student Support Plan

Student Name:

School:                                        Course:

Course Teacher:

Work Site:

Employer/Supervisor:

Plan:




        Course Teacher                                   Approved by Principal



        WBL Coordinator                                  Employer/Supervisor




             *Not applicable for students accessing WBL through “transition.”



                                          13
                                ACADEMIC COOPERATIVE EDUCATION
                                  STATEMENT OF UNDERSTANDING

All parties agree to the following conditions attached to Academic Cooperative Education.

         The job must be related to an advanced or culminating class (not a career and technical class).
         The teacher of the related class will make the evaluation of the co-op experience a part of the
          student’s grade for the class (20-25% for each grading period). The student will receive the same
          grade for the co-op experience as for the class.
         The co-op experience may affect the student’s class grade positively or negatively, which will in
          turn raise or lower the grade point average.
         Students co-oping through an accelerated, honors, or AP class will receive weighted points for the
          academic class but no additional quality points for the co-op credit.
         Students who fail to satisfactorily complete their workplace training plan may not receive credit for
          the co-op experience.
         Teachers who have students co-oping in a class could assign all students a special project each
          grading period accounting for 20-25 percent of the total grade for the class equivalent to the co-op
          student’s project. The special project for co-op students will be the cooperative education
          experience.
         The teacher of the related class and the work-based learning coordinator will work closely to
          develop a training plan for the student that includes competencies related to the curriculum
          framework of the class.
         Other conditions set forth in the Williamson County Schools WBL Guide will be followed.



Student’s Name

Related Class

Employer

Job Description:




SIGNATURES:

Parent:                                                                        date

Student                                                                        date

Teacher of related class                                                       date

Work-based Learning Coordinator                                                date




                                                     14
                    IV. a) WBL TRAINING AGREEMENT
The document on page 16 is the Training Agreement, It must be completed and signed by all of
the parties designated (the parent or guardian, the student, the work based learning
coordinator/supervising teacher, the principal, and the employer/supervisor).

The Training Agreement must be signed by all parties before the student can begin leaving
school as a WBL student.




                                            15
                              Work Based Learning Training Agreement
               A copy of this form must be on file at the school and at the work-site while the student is participating in the WBL experience.


Student Name                                                                     Work Site

Address                                                                          Address

City                                                Zip                          City                                                       Zip

Phone (                  )                          Grade                        Phone (                    )

DOB:                                                                             Supervisor
Job Title                                                                        Placement Date
           □ Paid                        □ Unpaid Training                       Starting Wage $                                         per hour

                                                     Typical Weekly Work Schedule
               Day                                                 Time of Work                                          Total Work Hours
                                                       From                                                 To
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
                                                                                              Total
Related Course and Course Code_____________________________________________

                                      WBL Activities (Check the activity that applies)
                         Service Learning                       Transition (9498)
                         Clinical / Health Science              Apprenticeship (Registered)
                         Cooperative Education (CTE)            Internship
                         Academic

We, the undersigned give permission for the above named student to participate in the WBL program, and we understand and agree to
meet the requirements of the program as provided in the WBL Guide approved by the State Board of Education. We verify the above
information is correct and is consistent with federal and state guidelines for work-based learning experiences.

Parent or Guardian                                                                                                        Date
Student                                                                                                                   Date
WBL Coordinator                                                                                                           Date
Principal                                                         School                                                  Date
Work Site Supervisor                                                                                                      Date

Note: It is the policy of the school district that no person on the basis of race, color, religion, national origin or ancestry, age, sex, marital status,
disability, or disadvantage should be discriminated against, excluded from participation in, denied the benefits of or otherwise be subjected to
discrimination in any program or activity. This form is subject to monitoring by the DOE and/or TDOL&WD.

Office Use Only:
(To be completed by WBL Coordinator)

     VERIFY WORKERS’ COMPENSATION COVERAGE:
      __         Yes         __         No __                 Not Applicable (explain)
                                                                       16
              IV. b) Transition Statement of Understanding
     (in addition to the WBL Training Agreement for Transition Students)

The document on page 18 is the Transition Statement of Understanding, It must be completed
and signed by all of the parties designated (the parent or guardian, the student, the work based
learning coordinator/supervising teacher, and the special education teacher).

The Transition Statement of Understanding must be signed by all parties before the student can
begin leaving school as a WBL student.




                                             17
                 Transition Statement of Understanding

All parties agree to the following conditions:
     The WBL job must be related to the student’s measurable post secondary goals.
     The student’s WBL coordinator and special education teacher, if different, will use WBL
        job performance data to determine progress toward IEP goals/objectives related to WBL.
     The WBL Coordinator and special education teacher, if different, will revise a student’s
        training plan/instructional program(s) if a student does not progress satisfactorily toward
        their IEP goals/objectives.
     Other conditions set forth in the Williamson County Schools WBL Guide will be followed.


Student’s Name __________________________________________

Job Placement ___________________________________________

Employer/Business Supervisor _______________________________

Job Description
_________________________________________________________________




SIGNATURES:

Student: __________________________________________ Date _________

Parent: ___________________________________________ Date _________

Work-Based Learning Coordinator __________________                          Date_________

Special Education Teacher ____________________________ Date ________

WCS Student Support Service
Coordinator/Transition                                                      Date ________




                                              18
               V.        STATE AND FEDERAL STANDARDS

The preceding page (page 20) is part of the Training Agreement as set forth in the “Work
Based Learning Handbook” published by the State Department of Education. These
standards address various issues regulated by federal and state laws and State
Department of Education guidelines. Some of the issues addressed include credits
earned, safety considerations, hazardous occupations, and specific requirements of the
Training Plan and Training Agreement.




            The State Work Based Learning Handbook can be fount at:
                   http://www.tennessee.gov/education/cte/wb/



            Information on Legal issues regarding WBL can be found at:
                http://www.tennessee.gov/education/cte/wb/doc/legal




                                         19
                              WORK BASED LEARNING PROGRAM / STANDARDS (TN)

          It is essential that students in both the university and technical paths have access to a system of such experiences to allow them to
apply classroom theories to practical problems and to explore career options at the work-site. Structured WBL experiences may include
registered apprenticeship, transition programs, cooperative education, internships, clinicals, school-sponsored enterprises, and service learning.
Structured learning experiences must be related to the student's career goals and must provide close student supervision.

          Structured WBL experiences may be paid or unpaid, may occur in a public, private, or non-profit organizations and may result in the
attainment of elective credit. Internships and clinicals, cooperative education, and registered apprenticeships provide structured WBL
experiences at the work-site. Service learning is an option for providing structured WBL experiences as special projects in the community where
students provide a service and simultaneously develop skills related to their career goals. Work-site training stations may be limited in many
communities; and school-sponsored enterprises may be utilized to simulate the workplace by providing WBL experiences at the school-site.

          Units of high school credit per year may be granted for the combination (related instruction in the school and the on-the-job training)
phases of WBL programs in accordance with Rules, Regulations and Minimum Standards, Tennessee State Board of Education, 0520-1-7.04
COORDINATION AND SUPERVISION OF STUDENT WORK EXPERIENCE.

Statutory Authority T.C.A. 49-5302 and 49-11-101

STANDARDS

Each WBL Program, in providing on-the-job training, will meet the following standards:
    1. A qualified teacher/coordinator shall head up the program.
    2. Jobs and training must relate to the class in which the student is receiving credit.
    3. To allow some flexibility, programs with ten (10) or more placements (except for health science programs and special education
        transition) shall have a minimum of eighty-percent (80%) related placements with a maximum of twenty-percent (20%) non-related
        placements. All non-related placements will still be noted. Placements that violate child labor laws are not allowed.
    4.   WBL coordinators will be provided time during the regular school day to coordinate and supervise students involved in on-the-job
        training through part-time employment.
    5. The student learner shall not displace other workers who perform such work.
    6. The student learner shall not be employed in an occupation that is detrimental to the minor's health, well being and progress in school.
        The student learner shall make passing grades in his/her regular schoolwork and WBL training in order to remain in the program.
        Hours worked must be monitored for the best interest of the student.
    7. The training sponsor will employ and compensate student learners in conformity with federal, state and local laws and regulations and
        in a manner not resulting in exploitation of the student learner for private gain.
    8. An individualized training agreement and an individualized training plan will be developed for each student learner.
    9. The training agreement provides that: (a) the work of the student learner in the occupations declared particularly hazardous, shall be
        incidental to this training, (b) such work shall be intermittent and for short periods of time, and under the direct and close supervision of
        a qualified and experienced person, (c) safety instructions shall be given by the school and correlated by the employer with on-the-job
        training and verification of safety instruction must be on file, (d) each written agreement shall contain the name of the student learner
        and shall be signed by the employer and the school coordinator or principal, (e) copies of each agreement shall be kept on file by both
        the school and the employer, and (f) Summary sheets must be filed with the state office.
    10. The training plan must provide the student learner with the opportunity to progress through the various phases of the occupation/job.
        The WBL coordinator will work with the employer to develop a training plan for the student learner. The student learner must be
        supervised on the job.
    11. The WBL experience must be conducted in accordance with the requirements of the Tennessee Child Labor Law and Federal Child
        Labor Provisions and Rules, Regulations, and Minimum Standards.
    12. The student learner who is sixteen (16) or seventeen (17) years of age enrolled in a WBL program under a written training agreement
        must be employed, when possible, during school hours for a portion of his/her work week. Saturday and Sunday hours alone do not
        qualify for credit.
    13. WBL training programs in schools operating on a twelve (12) month basis may enroll student learners during the summer months
        (June, July and August) provided that all the provisions and standards of the training agreement are met.
    14. Students may not work in jobs in which blood-borne pathogens may be present unless they are health occupation students and have
        taken the hepatitis series shots and passed the Universal Precautions/Blood-borne Pathogens Test with 100% accuracy (OSHA
        Standards).
    15. The law does not allow a student under eighteen (18) to drive vehicles to make deliveries, to sell or scan beer, or work around
        hazardous equipment.
    16. Students cannot be given WBL credit when they are paid for other training (i.e., Guard Duty, Reserves, and Cosmetology School).
    17. Students cannot be given credit for baby-sitting unless they are enrolled in a childcare class and work in a licensed child caring
        business.
    18. Students cannot be given credit for Home Health Care unless enrolled in Health Sciences.
    19. Students may work only in a licensed business (except certain Agriculture Cooperative Students).
    20. The WBL coordinator must make an on-site visit to each training agency at least once during each grading period.
    21. The WBL coordinator will reinforce on-the-job experiences with related classroom instruction.
    22. Students will be accepted into the program and informed of jobs without regard to race, color, national origin, sex, religion, creed,
        disadvantaging or handicapping conditions.
    23. Upon enrolling in another class in the same program of study, the student may choose to continue the job obtained for the original
        class. (Ex. A job for horticulture could be maintained for landscaping, a job for biology could be maintained for chemistry and the WBL
        coordinator has final approval for all placements).




                                                                      20
                         VI. PROGRESS REPORT
                                  AND
                      SAFETY TRAINING PLAN/RECORD

A Safety Training Plan/Record and Progress Report (See sample form on pages 22-25) must be
completed by the teacher of the related class and/or the Work-Based Learning Coordinator in
cooperation with the employer/supervisor; it will outline the skills/services the student will be
developing/performing during the training period.

Information regarding safety in the work place can be found at the following links.

                                       www.osha.gov.htm

                       http://www.osha.gov/SLTC/teenworkers/index.html




                                              21
                      VII. SAFETY TRAINING PLAN/RECORD

The Safety Training Plan/Record (see page 23 or 24) must be completed and signed by
the employer/supervisor, the work-based learning coordinator, and the student. The Safety
Training Plan/Record should identify all safety instruction to be provided by the school, the
employer/supervisor, or any other party. It shall also indicate when such training was provided
and by whom.
For students accessing WBL through Transition, this may include ongoing training and require
ongoing supervision.


   Basic safety rules may include, but are not limited to:

      Never permitting students to operate equipment without first being trained and checked
       out under the supervision of a worksite mentor
      Comply with all safety rules at the worksite
      Report unsafe conditions immediately
      Wear protective equipment or clothing
      Use the correct tool for the job
      Keep the work area clean and orderly
      Procedures in case of fire and weather-related emergencies
      Procedures to respond to electrical hazards
      Procedures to respond to chemical hazards
      Procedures for safe lifting, ergonomics, movements.
      Procedures for responding to and reporting sexual and other workplace harassment


   WBL Coordinators and employer/supervisors can use the Safety Training Plan/Record on
   page 23. The basic safety rules are listed and any other safety rules specific to the employer
   can be added. This record should be kept on file for five years.


   The Safety Training Plan/Record on page 23 should be completed and a copy must remain
   in the student’s files at school for 5 years, as well as at work.




   Information regarding safety in the work place can be found at the following links.

                                           www.osha.gov.htm


                           http://www.osha.gov/SLTC/teenworkers/index.html



                                                  22
                                                 Safety Training Plan/Record


Student Name                                                                        Work Site

Address                                                                             Address

City                                                Zip                             City                                                Zip

Phone (                     )                                                       Phone (                       )

DOB:                                               Grade:                           Supervisor



                                                                             Training Provided                             Date      100%
                 Safety Training Plan                                                                                               Accuracy
                                                                                    By                                   Provided
                                                                                                                                     Yes / No




*if not 100% passing, then the student must re-train, re-test, and/or be supervised by school staff.

     1. Must attach test to Safety Training Record
     2. Must pass safety test with 100% accuracy (written or performance based)
     3. Form MUST be kept on file for 5 years


Parent or Guardian                                                                                                          Date

Student                                                                                                                     Date

WBL Coordinator/Supervising Teacher                                                                                         Date

Related Class Teacher (if different from WBL Coordinator – must be active participant in development of training plan)      Date

Principal                                                                                                                   Date

Work Site Supervisor                                                                                                        Date
Note: It is the policy of the school district that no person on the basis of race, color, religion, national origin or ancestry, age, sex,
marital status, disability, or disadvantage should be discriminated against, excluded from participation in, denied the benefits of or
otherwise be subjected to discrimination in any program or activity. This form is subject to monitoring by the DOE and/or TDOL&WD.

                                                                               23
                                                      (Transition Example)


                                Safety Training Plan / Progress Report
            Using the flowing scale, assess student’s progress for each grading period.
      Grading     4=Skilled    3=Moderately       2=Limited      1=Unsuccessf 0=No
      Scale                    Skilled               Skilled     ul             Exposure

                                                                                                GRADING PERIODS
                  WORK-BASED COMPETENCIES                                                      1    2    3      4
1.     Wears clean, appropriate work attire
2.     Personal hygiene and grooming appropriate
3.     Greets supervisor and co-workers appropriately
4.     Checks for work assignments/asks questions for
       clarification
5.     Follows daily work schedule and procedures
6.     Accepts the supervision from WCS staff or job site staff
7.     Stays on a task until completion of task
8.     Is able to stay on task/job for an hour
9.     Is able to stay on task/job for 90 minutes
10.    Is able to stay on task for longer than 2 hours
11.    Is able to begin new task; sees what needs to be done
12.    Demonstrates acceptable work rate
13.    Will ask for assistance from WCS or job site staff as
       appropriate
14.    Follows safety procedures at work site
15.    Follows safety procedures to and from work site
16.    Demonstrates appropriate social interactions at work
       site
17.    Takes break at appropriate time; will ask if break
       needed earlier
18.    Works cooperatively with others
19.    Calls WCS teacher/staff if going to be absent/tardy
20.    Demonstrates motivation for job tasks at job site
21.    Is respectful to self and others
22.    Cleans up work area when finished
23.    Let’s work supervisor know when leaving for day
24.
25.    (Add other job specific tasks below OR attach rubric for
       job site)
26.
27.

         Note: It is the policy of the school district that no person on the basis of race, color, religion, national origin or ancestry, age,
           sex, marital status, disability, or disadvantage should be discriminated against, excluded from participation in, denied the
        benefits of or otherwise be subjected to discrimination in any program or activity. This form is subject to monitoring by the DOE
                                                                  and/or TDOL&WD.




                                                                    24
                                         Progress Report
            Using the flowing scale, assess student’s progress for each grading period.

      Grading
      Scale:     4=Skilled   3=Moderately Skilled   2=Limited Skilled   1=Unsuccessful   0=No Exposure



                                                                                GRADING PERIODS
                     WBL COMPETENCIES
                                                                                1        2     3     4
         RELATED TO COURSE STANDARDS & WORK ETHIC
28.

29.

30.

31.

32.

33.

34.

35.

36.

37.

38.

39.

40.

41.

42.

43.

44.

45.

46.


                                                    25
         VIII. INSURANCE AND EMERGENCY INFORMATION

The Insurance and Emergency Information form (see page 27) must be completed by the
student and signed by the student, parent/guardian, work-based learning coordinator,
principal, and employer/supervisor.

This must be kept on file for 5 years.




                                         26
  Work Based Learning Insurance and Emergency Information
Student Name                                                  Work Site
Address                                                       Address
City                                   Zip                    City                                      Zip
Phone (            )                                          Phone (           )
DOB:                                      Grade:              WBL Coordinator


                                             Student Medical Information

Allergic to Medication? ( ) Yes, If yes, what medication?
                        ( ) No

List any other allergies or medical problems:



Medical Alert: ___ Yes                    ___ No            Health/Accident Insurance ___ Yes ___ No

Insurance Company: ______________________________Policy #_______________________

Parent/Guardian                                               Home Phone: (     )
                                                              Work Phone : (    )
                                                              Cell Phone : (    )
Address                                         City                                                   Zip

Parent/Guardian                                               Home Phone: (     )
                                                              Work Phone : (    )
                                                              Cell Phone : (    )
Address                                         City                                                   Zip

Additional Emergency Contact                                  Home Phone: (     )
                                                              Work Phone : (    )
                                                              Cell Phone : (    )

I consent for my child to receive medical treatment in case of injury or illness. The information
provided is accurate to the best of my knowledge.

Parent or Guardian                                                                         Date

Student                                                                                    Date

WBL Coordinator                                                                            Date
Supervising Teacher
Principal                                                                                  Date

Employer/Supervisor                                                                        Date



Note: It is the policy of the school district that no person on the basis of race, color, religion, national origin or
ancestry, age, sex, marital status, disability, or disadvantage should be discriminated against, excluded from
participation in, denied the benefits of or otherwise be subjected to discrimination in any program or activity. This form
is subject to monitoring by the DOE and/or TDOL&WD.
                                                         27
                           IX    TRANSPORTATION

The Transportation form (see page 29) must be completed and signed by a parent or
guardian in the appropriate sections and returned to the work-based learning coordinator
before the student can begin leaving school as a co-op student.

If the student will be driving to the work-site, a copy of the student’s driver license and
a copy of the “certificate of insurance” (not copy of insurance card) on the vehicle
being used must be provided to the work-based learning coordinator before the student
can begin leaving school as a co-op student. This information can be faxed to your
school from the insurance company.

A student shall not ride with or provide transportation for another student; no
exceptions.




                                          28
                       STUDENT PROVIDED TRANSPORTATION
All students will be required to furnish a “Certificate of Insurance” on the vehicle(s) they will be
driving prior to being released to go to the co-op job or work-based learning site during school hours.
The certificate of insurance can be obtained by contacting your insurance agent. Also, students will he
required to furnish a copy of their driver’s license.

1.     I give my permission for my son/daughter,
       to drive his/her car when going directly to his/her co-op job or work-based learning site from
       school. I agree to hold The Williamson County Board of Education and Williamson County,
       Tennessee harmless and to defend both in the event of an accident.



                                                           Parent/Guardian’s Signature


                                                           Date

2.     I understand that my son/daughter shall not provide transportation for another student to or from a
       WBL placement. I have discussed this policy with my son/daughter.



                                                           Parent/Guardian’s Signature


                                                                  Date



                        System Provided Transportation
     Permission for Transportation, Unpaid/Training Employment Experience

In addition to my son’s/daughter’s transition plan, ________________________              will be
participating in community based transition and work based learning outside of the high school.
Students will be leaving their high school campus at different times/days during the school week.
Your child’s teacher will provide you with their schedule. The work experience is designed so
that students are given opportunities for meaningful work. Time spent at a community site will
vary, dependent on student’s IEP.
In order to travel to the community sites, students will be transported by a bus or other public
transportation. Buses will be driven by trained and certified personnel who are also Student
Support Services Job Coaches.


___________/____________(Parent &Student initial). We agree to Williamson County
Schools providing the undersigned student transition community transportation through
a bus or other public transportation.


                                                 29
                         X.       NINE WEEKS EVALUATION

Co-op Students:

Each nine weeks grading period, the student will be evaluated by the employer. The evaluation will be
based upon mastery of competencies identified by the Training Plan. It is the student’s responsibility to
return the evaluation to school by the specified time. If the student is a co-op student, this evaluation will
be used as part of the class grade (in the class related to the co-op experience) and will become a part of
the student’s co-op record. The WBL Coordinator will visit the work site once each nine weeks.


Service Learning Students:

Reflection is a key component of service learning. The service learning coordinator will arrange for both
individual and group reflection time on a regular basis within each nine week grading period. The service
learning supervisor at the work site will also evaluate the student each nine weeks. Service Learning
students receive a pass/fail grade on their progress reports. The WBL coordinator will visit the work site
once each nine weeks.

Transition Students:
(Students accessing WBL through transition option, and does not include students labeled as
gifted or students with IEPs accessing WBL through general education WBL options.)

Each nine weeks grading period, students who access work-based learning through transition options,
other than students who are labeled gifted, will be evaluated by the worksite business
supervisor/employer and the student’s Transition WBL Coordinator. It is the student and the Transition
WBL Coordinator’s responsibility to obtain the supervisor’s/employer/s “Work-based Learning Site
Feedback Record” by the specified time. The Transition WBL Coordinator will use information from the
supervisor/employer Site Feedback along with feedback from the Training Record and other data
collection from special education personnel to evaluate student progress toward the work-based learning
goal(s) and objectives.


WBL Coordinator Travel Guidelines

WBL coordinators are required to visit each WBL student one time per grading period. Therefore, the
WBL coordinator will be reimbursed for one visit per grading period per student. If more than one student
is at a worksite, the WBL coordinator will be reimbursed for only one visit to that site each grading period.
A Work-Based Learning Coordinator Travel Log and Mileage Reimbursement claim form (page 31) must
be turned in at the end of each grading period. As of August 2, 2011 the mileage rate is $0.46. This rate
may change at any time.             Use the point to point miles as found on Map Quest.
(http://www.mapquest.com/)

When WBL coordinators are not visiting students they shall make random calls to work sites to check on
students.

Transition Work-Based Learning Coordinator Travel Guidelines

In the event the Transition WBL Coordinator is not the site supervisor, WBL coordinator travel for defined
dates and locations will be reimbursed only upon prior written approval from the Student Support
Coordinator.



                                                   30
                       Work-Based Learning Coordinator Travel Log
                              And Mileage Reimbursement
        This log must accompany your mileage reimbursement request. If this form is not submitted, we
        will not be able to authorize reimbursement. Coordinators should be completing the Work-Based
        Learning Travel Log whether or not they request mileage reimbursement.

                WBL coordinators must submit the Work-Based Learning Travel Log at the end
                 of each grading period by: October 13 / December 15 / March 16 / May 25
                                                                               School              Worksite
 Date of            Student                                     Miles
                                      Worksite Destination                  Administration        Supervisor
site visit           Name                                       Driven
                                                                             Verification         Verification




        I verify this is a true and accurate account of my travel for which I am requesting reimbursement.

        WBL Coordinator:                                       Employee Number

        School                                    Date
          ALL MILEAGE MUST BE SUBMITTED AND IN THE HANDS OF THE FINANCE DEPART
          WITHIN 60 DAYS OF TRAVEL. CLAIMS RECEIVED IN THE FINANCE DEPARTMENT IN
                    EXCESS OF 60 DAYS FROM TRAVEL DATE WILL NOT BE PAID.

                                 Appropriation Code:

                                                       31
                              XI. TIME/WAGE RECORD

Students are responsible for maintaining an accurate record of hours worked or volunteered each day
and total hours for each week. A Time/Wage Record (pages 33 to 36) must be updated at least once
each week.

The time sheet should be kept at school in a folder provided by the work-based learning coordinator or
related WBL teacher. The work-based learning coordinator will verify with the employer/supervisor the
hours reported on the time/wage record.




                                                 32
 st
1 NINE WEEKS - WBL STUDENT EMPLOYMENT/SERVICE TIME/WAGE RECORD


STUDENT’S NAME                                        RELATED CLASS

WORKSITE                                              RATE OF PAY (if Applicable)

ON-THEJOB SUPERVISORS NAME


                                                                                                        TOTAL
 SUNDAY         MONDAY       TUESDAY    WEDNESDAY     THURSDAY              FRIDAY          SATURDAY
                                                                                                        HRS / $
 July 31,2011     Aug. 1            2            3                   4                 5           6



           7             8          9           10                 11                12           13
                                                          First day for
                                                              students     First full day
                                                                 ½ day     for students
          14           15          16           17                 18                19           20



          21           22          23           24                 25                26           27



          28           29          30           31           Sept. 1                   2           3
                                                                                   Staff
                                                                          Development-
                                                                                 ½ day
                                                                               students

           4             5          6            7                   8                 9          10

                Labor Day-
                 No School
          11           12          13           14                 15                16           17



          18           19          20           21                 22                23           24



          25           26          27           28                 29               30         Oct. 1



           2             3          4            5                   6                 7           8




                       *COMPLETD TIME RECORD AND EVALUATION DEADLNE. SUBMIT TO TEACHER*


JOB SKILLS PERQRMED:

1.
2.
3.

                                                     33
4.

    ND
2        NINE WEEKS - WBL STUDENT EMPLOYMENT/SERVICE TIME/WAGE RECORD


STUDENT’S NAME                                                     RELATED CLASS

WORKSITE                                                           RATE OF PAY (if Applicable)

ON-THEJOB SUPERVISORS NAME


                                                  WEDNESDA                                                  TOTAL
    SUNDAY        MONDAY          TUESDAY            Y
                                                                   THURSDAY       FRIDAY         SATURDAY
                                                                                                            HRS / $
          Oct 9          10                  11            12             13              14           15
                                Parent/Teacher
                                 Conferences-        End of 1st
                                   No students        Quarter
             16          17                  18            19             20              21           22

                    No School – Fall Break

             23          24                  25            26             27              28           29



             30          31             Nov. 1               2             3                4           5



              6            7                  8              9            10              11           12



             13          14                  15            16             17              18           19
                                                                                         Staff
                                                                                Development-
                                                                                    ½ day for
                                                                                     students
             20          21                  22            23             24              25           26
                                        THANKSGIVING HOLIDAY- NO SCHOOL


             27          28                  29            30          Dec. 1               2           3



              4            5                  6              7             8                9          10




                         *COMPLETD TIME RECORD AND EVALUATION DEADLNE. SUBMIT TO TEACHER*


JOB SKILLS PERQRMED:

1.
2.
3.
4.



                                                                  34
    RD
3        NINE WEEKS - WBL STUDENT EMPLOYMENT/SERVICE TIME/WAGE RECORD

STUDENT’S NAME                                                      RELATED CLASS

WORKSITE                                                            RATE OF PAY (if Applicable)

ON-THEJOB SUPERVISORS NAME


                                                                                                                TOTAL
    SUNDAY          MONDAY         TUESDAY         WEDNESDAY        THURSDAY         FRIDAY          SAT
                                                                                                                HRS / $
             11              12              13              14               15                16         17

                                                                        FIRST SEMESTER EXAMS


             18              19             20               21               22                23         24
                                      ½ day for
                                      students
                      FIRST SEMESTER EXAMS                          WINTER HOLIDAY- NO SCHOOL
                                      End of 1st
                                      Semester
             25              26              27              28               29                30         31

                                                   WINTER HOLIDAY- NO SCHOOL


     Jan.1, 2012              2               3               4                5                6          7
                                                                    First Student
                          WINTER HOLIDAY
                                                    Admin. Day-          Day 2nd
                                                    All Teachers       Semester
              8               9              10              11               12                13         14



             15              16              17              18               19                20         21

                      MLK – No
                        School
             22             23               24              25               26                27         28



             29              30              31          Feb. 1                2                3          4


              5               6               7               8                9                10         11
                                   TCAP Writing
                                    Assessment
             12              13              14              15               16               17          18
                                                                                             Staff
                                                                                    Development-
                                                                                        ½ day for
                                                                                         students
             19              20              21              22               23               24          25
                           Staff
                   Development-
                      No School
             26              27              28              29         March 1                 2          3




                             *COMPLETD TIME RECORD AND EVALUATION DEADLNE. SUBMIT TO TEACHER*
JOB SKILLS PERQRMED:

1.
2.

                                                                   35
3.
4.
 TH
4     NINE WEEKS - WBL STUDENT EMPLOYMENT/SERVICE TIME/WAGE RECORD


STUDENT’S NAME                                              RELATED CLASS

WORKSITE                                                    RATE OF PAY (if Applicable)

ON-THEJOB SUPERVISORS NAME


                                                                                                    TOTAL
    SUNDAY       MONDAY       TUESDAY          WEDNESDAY    THURSDAY      FRIDAY         SATURDAY
                                                                                                    HRS / $
     March 4              5               6            7            8               9          10
                                                                          Site Based
                                 End of 3rd                               Staff Dev –
                                   quarter                                No School
           11          12               13            14          15              16           17



           18          19               20            21          22              23           24
                              ACT Testing-
                              All 11th grade
                                   students
           25          26               27            28          29              30           31
                                                                                 Staff
                                                                        Development-
                                                                            ½ day for
                                                                             students
       April 1            2               3            4            5               6           7
                                      SPRING BREAK – NO SCHOOL


             8            9             10            11          12              13           14



           15          16               17            18          19              20           21



           22          23               24            25          26              27           28


           29          30          May 1               2            3               4           5


             6            7               8            9          10              11           12



           13          14               15            16          17              18           19
                                                                          SMESTER
                                                                           EXAMS

                       *COMPLETD TIME RECORD AND EVALUATION DEADLNE. SUBMIT TO TEACHER*

JOB SKILLS PERQRMED:

1.
2.
                                                           36
3.
4.
     TH
4         NINE WEEKS - WBL STUDENT EMPLOYMENT/SERVICE TIME/WAGE RECORD


STUDENT’S NAME                                             RELATED CLASS

WORKSITE                                                   RATE OF PAY (if Applicable)

ON-THEJOB SUPERVISORS NAME


                                                                                                   TOTAL
     SUNDAY         MONDAY   TUESDAY     WEDNESDAY         THURSDAY       FRIDAY    SATURDAY
                                                                                                   HRS / $
           May 20       21          22             23              24          25             26
                                              Last day
                                              students

                             SMESTER EXAMS                                GRADUATION WINDOW
                                                           Admin. Day-
                                             End of 2nd
                                                           All teachers
                                             Semester
              27        28          29             30              31


GRADUATION
 WINDOW




                                                          37
                 *COMPLETD TIME RECORD AND EVALUATION DEADLNE. SUBMIT TO TEACHER*




                XII. END OF THE YEAR EVALUATIONS

Both students and employer/supervisors must evaluate the Work-Based Learning
Program. The forms on pages 38 and 39 must be completed by the WBL student
and the WBL employer.

Both forms must he kept on file for a period of five years.




                                             38
                   Student Evaluation of the Work-Based Learning Activity

Student Name:

WBL Activity:

Employer/Supervisor:

Place a check in the space beside each rating which best describes your WBL experience.

1.       How would you rate the experience?

                  Excellent_____ Good_____ Average_____ Poor_____

2.       Did the experience meet your expectations?
         Explain.

3.       Do you feel the employer exposed you to a variety of responsibilities related to the occupation you
         were experiencing?
         Explain.




4.       Did the experience change your mind about your career plans or impact your life in any way?
                  Yes_____             No_____   If yes, explain




5.       What was the most valuable activity you experienced?




6.       How can the WBL program be improved?




Additional Comments




2011/2012 – Keep on file until August 2016


Note: Return to coordinator and/or teacher.




                                                      39
         Employer/Supervisor Evaluation of the Work-Based Learning Activity


Student Name: ________________________________________________________

WBL Activity: _________________________________________________________

Employer/Supervisor: ____________________________________________________

     Place a check in the space beside each rating which best describes your WBL experience.

1.       How would you rate the student’s learning experience?

                  Excellent __        Good __   Average __   Poor __



2.       Were the WBL and school-based learning competencies identified in the training plan
         accomplished?

         Explain




3.       Were the work-site visits by the coordinator regular and systematic? Explain.




4.       Were you provided appropriate opportunity for input for determining learning competencies and in
         evaluating the student? Explain




5.       What were the advantages of this program to your business?




6.       How can the program be improved?




Additional Comments:




2010/2011 – Keep on file until August 2015


Note: Return to coordinator and/or teacher
                                                    40
  XlII. INFORMATION FOR WBL EMPLOYERS/SUPERVISORS

Employers/Supervisors are provided with a packet at the beginning of or prior to
the training period. The packet is made up of a cover sheet (see pages 41 or 42)
outlining some of the expectations of students and employers/supervisors
participating in the WBL program and a sample safety plan.

Employers working with co-op students receive a letter from the Commissioner of
the Department of Employment Security (page 43) stating that co-op students are
“not reportable for unemployment insurance purposes.”




                                     41
                       INFORMATION FOR CO-OP EMPLOYERS

       The Cooperative Education Program combines classroom instruction with on-the-job
training in related employment. The student must have the recommendation of his or her
instructor before being eligible to participate in the program. Co-op employment is considered to
be an extension of the classroom and a continuation of learning in an actual work setting. A
training plan is prepared (with input from the employer) to insure that the student is gaining
competencies related to the instructional program.

       Students in the co-op program are required to attend the related class an equivalent of
five hours per week, in addition to their other daily academic classes. The students work
schedule may vary according to the need of the employer and the school, but the student must
report to work during school hours for a portion of his/her work period. The student’s
employment must average a minimum of 10 hours per week. This minimum average may
include hours worked on weekends or holidays if applicable. Depending upon their schedules,
some students will need to average 20 hours per week. Employers are required to pay their
student workers at least minimum wage.

       Each semester, the student must pass all classes in order to remain eligible for the co-op
program. If a student receives a progress report that indicates a failing course, the WBL
Coordinator will develop a plan of support in conjunction with the teacher of the failing course
and with the employer/supervisor. This plan may include limitation of daily WBL release time in
order to provide the necessary support to the student. This WBL Student Support Plan must be
approved by the principal.

       As a co-op employer, you will be asked to complete an evaluation form on your student-
employee each nine weeks, coinciding with the school grading periods. Your evaluation will
comprise a large percentage of the students’ grade and is important in helping the instructor
assess the progress of the co-op student. The progress form may be returned to the school by
the student.

      Also, you are requested to provide safety instructions and a written safety play for your
co-op student worker (see attached form).

       If a co-op student is absent from school, he/she is not allowed to report to his job during
school hours that day. This discourages students from missing school since most students’
value the time on their co-op job. A student not abiding this rule may lose co-op privileges.

       Without the participation of you and other local employers, our co-op Program could not
exist. We welcome your ideas and suggestions and we look forward to working with you to
provide a quality learning experience for students. If you wish more information or would like to
discuss the student-employee or any aspect of your role as a co-op employer, please call the
Work-Based Learning Coordinator.

        Thank you for offering a training experience to a vocational student. We appreciate your
participation very much.




                                               42
                          Information for Transition Employers


Thank you for being a partner with Williamson County Schools by offering your business as a
means to teach students with a transition plan the opportunity to learn critical job skills and work
habits. Your business will be considered an extension of the student’s classroom. Students will
be accompanied and supervised by trained job coaches, with the understanding that students
will be given opportunities for training and mentorship from employees to create a natural
support system. Work experiences may be paid or, if there is no employer-employee relation,
non-paid.

 Our mission is to prepare our students for a more independent life by providing job training
experiences within our community. We believe that teaching them job skills within a business
setting will enhance their opportunity for finding meaningful work when they leave school.
Students will learn skills that will help them retain a job, along with giving them the opportunity
for feel good about their accomplishments in a work setting. Students will also learn how to
develop relationship with co-workers at the job site. Students will be supervised by school
personnel.

As a business partner, you will be provided and asked to complete an evaluation and feedback
form, at least every nine weeks, which rates the performance of student learners in your
business. In addition, your feedback provides Williamson County valuable information related to
improving opportunities to students.

The benefit to your business is that you are providing a valuable opportunity to train students by
providing your site as a training venue. Having students come to your business often results in
morale boosting among your workers, along with being introduced to a potential work force.
Without the participation of you and other local employers, our program could not exist. We
welcome your ideas and suggestions, and we look forward to working with you to provide a
quality learning experience for students.

If you would like more information or would like to discuss the employer-student partnership, or
any aspect of your roll, please contact Student Support Services at 472-4130.




                                                43
44
          XIV. STUDENTS WHO WORK IN OCCUPATIONS
                    DEEMED “HAZARDOUS”

Students who work at a job that is deemed “hazardous” by the State• of Tennessee Department
of Labor and Workforce Development, Child Labor Division, will need to complete the Child
Labor Law Hazardous Occupation Student Learner Exemption Agreement located on page 45.

If you have questions about the list of occupations deemed “hazardous”, please call the State of
Tennessee Department of Labor and Workforce Development Office, Child Labor Division, at
615-741-2858.

*Copies of this signed document are to be in the student’s file at school and at work.




                                             45
                          Child Labor Law Hazardous Occupation
                          Student Learner Exemption Agreement

Last Name                      First Name               Mi                     Date of Birth


       District                                School                          Training Program #




        CHECK THE HAZARDOUS OCCUPATION FOR WHICH THE EXEMPTION APPLIES:

    Work using power-driven woodworking machines, including the use of saws on construction sites.
    Work using power-driven metal forming, punching, and shearing machines (but HO8 permits the use of
     large group of machine tools used on metal, including lathes, turning machines, milling machines, grinding,
     boring machines, and planning machines.)
    Work involving slaughtering or meatpacking, processing, or rendering including the operation of power-
     driven meat slicers in retail stores.
    Work using power-driven paper-products machines, including the operation and loading of paper balers in
     grocery stores.
    Work involving the use of circular saws, band saws, and guillotine shears.
    All work in roofing operations.
    All work in excavating operations, including work in a trench as a plumber.



In accordance with T. C. A. & 50-5-107 (10), (11) and (12), the undersigned attest to the following:
      1. The student learner is enrolled in a youth vocational training program under a recognized state
         or local educational authority.
      2. The work of the student learner in the occupation declared particularly hazardous is incidental to
         the training received.
      3. That the work performed shall be intermittent and for short periods of time and under the direct
         and close supervision of a qualified and experienced person.
      4. That the safety instructions shall be given by the school and correlated by the employer with on-
         the-job training.
      5. That the student has a schedule of organized and progressive work processes to perform on
         the job.

     ___________________________________                       _____________________________
     Student’s Name (print)                                    Student’s Signature

     ___________________________________                       _____________________________
     Parent’s or Guardian’s Name (print)                       Parent’s or Guardian’s Signature

     ___________________________________                       _____________________________
     Employer’s Name (print)                                   Employer’s Signature

     ___________________________________                       _____________________________
     Coordinator’s Name (print)                                Coordinator’s Signature

     ___________________________________                       _____________________________
     Principal’s Name (print)                                  Principal’s Signature




                                                    46
                              SAFETY CONCERN TEST

Directions:   Ask your supervisor these questions. Please have your supervisor sign this sheet
              after you have answered these questions.

   1. What do I do if I get hurt on the job?


   2. What should I do in case of accident or illness of another employee or customer?


   3. Where is the first-aid kit?


   4. What should I do in case of fire?


   5. Where is the fire extinguisher? How does it work? Can I use the extinguisher on any
        type of fire?


   6. Do we have a policy/plan regarding tornados?


   7. What do I do if there is power failure?


   8. What do I do if there is a robbery?


   9. What should I do in case I suspect someone of shoplifting, theft, or employee theft?


   10. Should I attempt CPR or other life saving techniques?


   11. Who is ultimately responsible for my safety?


   12. Does this company have a safety handbook, check list, video, etc.. that I should
         read/watch?


   13. Who among my coworkers has had First Aid Training?


   14. What are the emergency phone numbers that I should know for work? Can I call 911?



Student Signature                   Date              Employee Supervisor Signature       Date
                                                47
                                       General Safety Test
Student Name

School
                                                                                     True / False
   1) Only major injuries need to be reported to your supervisor.

   2) All employees should be familiar with calling 911 for emergencies.

   3) Alcoholic beverages are permitted on state property.

   4) Narcotics can be used on the job if they are doctor prescribed and your
      supervisor knows.

   5) Never remove safety warnings.

   6) Horseplay is okay as long as no one gets injured.

   7) Lift what you want regardless of the weight.

   8) Cleanliness shall be maintained in all work areas.

   9) Operate equipment once you have been approved to do so.

   10) Never use a box or bucket for climbing.

   11) Observe and obey all safety signs.

   12) Report all damaged equipment.

   13) It is okay to make electrical repairs even if you have not been authorized.

   14) Hang articles from building fire sprinklers when necessary.

   15) You may store supplies/materials in stairways.

   16) Maintain adequate access to electrical panels.

   17) Open doors as quickly and fast as possible as you go in and out of doors.

   18) Fire doors should not be blocked.

   19) See the stair treads when carrying items up or down the stairs.

   20) Know where the fire extinguisher is located in your area/building.

   21) Burning decorative candles is permitted.

   22) Do not run over cords and computer cables with carts/chairs.

   23) Report unsafe conditions to your friend, but not your supervisor.

   24) Wipe all spilled liquids immediately.

   25) Employees may stand in the back of moving trucks.
                                                     48
                         XVI. FREQUENTLY ASKED QUESTIONS

How many credits can be earned in co-op?
     For students who co-op through a Career and Technical Education class, one credit is earned for the
     class and, depending on hours worked, up to two credits for the co-op component. If a student
     averages 20 hours per week for the school year, two additional credits are earned. Students averaging
     10 or more hours per week, but not 20, earn one additional credit. For students who co-op through an
     academic program, a maximum of 1 credit can be earned for the school year in addition to the related
     class, and an average of 1.0 hours per week must be maintained


Will students who co-op through a class that has additional quality points for calculating grade point
average receive additional quality points for the additional credit for cooperative education?
        No. Students will only receive additional quality points for one unit of credit.


May juniors participate in WBL?
       By law, juniors or seniors 16 years of age or older may participate in WBL. This is a local decision. In
       Williamson County, juniors must have the approval of the WBL Coordinator and principal in order to
       participate in WBL.


Is WBL part of school-to-career?
      Yes. It has been a very successful component for many years.


What is the difference between co-op and internship?
       A student internship provides a student the opportunity to study a program directly related to his or her
       career interest and to participate in a workplace setting by performing duties related to the occupation
       being studied. The student may or may not be paid. Internships, as a component of a related course,
       are intended to be short-term activities. Long term, for credit experiences, may be pursued through
       cooperative education. Cooperative education students must be paid.


At what time will students be allowed to leave school each day?
      In order to be counted as a full-time student, the student cannot be released more than 120 minutes
      before the end of the school day.


After I work the required number of hours, can I quit working?
        No, remember this is an educational experience designed to provide you with skills and competencies,
        not just work experience. The required number of hours is a minimum and serves as a guideline, not
        a limit. To receive credit, you must work the duration of the related class.


What happens on days with schedule changes due to testing, assemblies, or bad weather?
      School and classes are your first priority. You must attend your classes. Be sure to contact your
      employer as soon as you are aware of impending schedule changes and make necessary
      arrangements. You must report to work on holidays and school days canceled because of bad
      weather, according to the requirements of your employer.


I want to change jobs, what do I need to do?
        Before you make any job changes, you must discuss the reasons with your coordinator. TO avoid
        having your grade penalized, you must have your coordinator’s permission before changing jobs. The
        WBL program is a learning experience, not just a part-time job.
                                                     49

				
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