Work Based list by O3L09H

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									   WORK-BASED LEARNING FOR SPECIAL EDUCATION (students with disabilities)
                   LIST OF ENROLLED PUPILS
       District:                                                                                                                                                         School Year:

Building/Program:                                                                                                                                                                          Count:             *       Sept.                 *          Feb.

INSTRUCTIONS: Complete this form for Special Education pupils who are placed in an In-District Placement course per their
                            transition plan on the September or February count day. Indicate requirements have been met with Y/N.
                                                   In-District Placement (IP)
                                 Two types
                                                   Non-CTE Special Ed Pupil (NCTE)




                                                                                                                                         HS Credit Earned




                                                                                                                                                                                                                                   School Maximum
                                                                        Program Type IP




                                                                                                                                                                                                               site Counted does




                                                                                                                                                                                                                                                     FTE Claimed for
                                                                                                                                                                                                                                   Must not Exceed
                                                                                                                                                                                                               Hours at Work-
                                                                                                                                                                                           Visitation every




                                                                                                                                                                                                               not exceed 50%
                                                                                                                                                                         Safety Training
                                                                                                         Training Plan

                                                                                                                         Monitored by




                                                                                                                                                                                                                                                     Workbased
                                                                                                                                                            Attendance
                                                                                          Agreement




                                                                                                                                                                                           applicable)
                                                                                                                                                                                           30 Days (if
                                                                                                                         Special Ed
                                                                        or NCTE




                                                                                                                                                                                                                                                     Learning
                                                                                          Training




                                                                                                                                                            Verified
                                                                                                                         Teacher




                                                                                                                                                                                                                                   Hours
     Pupil Name                                     Grade      Hour
1. Smith, Michael (sample)                           11th       3rd         IP              Y            Y                   Y            Y                    Y         Y                     NA                    Y                  Y               0.16
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
I certify that this is a true and accurate list of pupils enrolled in Work-Based Education / In-District Placement Programs.

Authorized Representative's Signature                                                                 Title of Authorized Representative                                                                      Date
                                                                                                                                  Genesee ISD/DH:hw/10-16-07/Pupil Accounting/Forms 07-08/Work Based
             WORK-BASED EDUCATION NON-CTE APPROVED PROGRAMS
                          LIST OF ENROLLED PUPILS
        District:                                                                                                                                                      School Year:

 Building/Program:                                                                                                                                                                        Count:             *       Sept.         *                   Feb.

                             Complete this form for all pupils in a paid or unpaid work experience on the September or February
INSTRUCTIONS:
                             count day. Indicate requirements have been met with Y/N.




                                                                                                                                       HS Credit Earned




                                                                                                                                                                                                                                   School Maximum
                                                                                                                                                                                                               site Counted does




                                                                                                                                                                                                                                                     FTE Claimed for
                                                                                                                                                                                                                                   Must not Exceed
                                                                                                    School Certified




                                                                                                                                                                                                               Hours at Work-

                                                                                                                                                                                                               not exceed 50%
                                                                                                                                                                        Safety Training

                                                                                                                                                                                           Visit Work-site
                                                                                    Training Plan




                                                                                                                                                                                           every 9 weeks
                                                                                                    Monitored by




                                                                                                                       Related Class




                                                                                                                                                                                                                                                     Workbased
                                                                                                                                                          Attendance
                                                                                                                       Enrolled in
                                                                      Agreement




                                                                                                                       Currently




                                                                                                                                                                                                                                                     Learning
                                                                      Training




                                                                                                                                                          Verified
                                                                                                    Teacher




                                                                                                                                                                                                                                   Hours
     Pupil Name                                   Grade     Hour
1. Smith, Michael (sample)                         12th       6th       Y            Y                    Y                Y            Y                    Y          Y                      Y                     Y                  Y               0.17
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
I certify that this is a true and accurate list of pupils enrolled in Non-CTE Work-Based Education Programs.


Authorized Representative's Signature                                             Title of Authorized Representative                                                                                         Date
                              WORK-BASED EDUCATION STATE-APPROVED CTE PROGRAMS
                                           LIST OF ENROLLED PUPILS
            District:                                                                                                                                                                    School Year:
   Building/Program:                                                                                                                                                                             Count:            *       Sept.        *        Feb.

                                    Complete this form for all pupils in a paid or unpaid work experience on the September or February count day. Indicate requirements
   INSTRUCTIONS:
                                    have been met with Y/N.
              Capstone (Cap)        1. Completed 50% of State-Approved CTE program 2. Works min. of 10 hours per week 3. Attends CTE related course min of 40 mins. per week
        Unpaid Learner (UL)         Documented new experience every 45 hours
 In-District Unpaid worker          Documented new experience every 45 hours
    CTE Approved (IDUW)
 State Approved CTE Less-           1. Signed notification by OCPT 2. Time equivalent to State-Approved CTE Program 3. No more than 4 pupils per instructor 4. Instruction by LTCS annually
   Than-Class-Size (LTCS)           authorized personnel




                                                                         Student Enrolled
                                                                         Cap, UL, IDUW,




                                                                                                                                               HS Credit Earned
                                                                         Which Program




                                                                                                                                                                                                                                        School Maximum
                                                                                                                                                                                                                    site Counted does
                                                                                                         Written Training




                                                                                                                                                                                                                                        FTE Claimed for
                                                                                                                                                                                                                                        Must not Exceed
                                                                                                                            (Capstone Only)
                                                                                                                            School Certified




                                                                                                                                                                                                                    Hours at Work-

                                                                                                                                                                                                                    not exceed 50%
                                                                                                                                                                               Safety Training


                                                                                                                                                                                                 Visit Work-site
                                                                                                                                                                                                 every 9 weeks
                                                                                                                            Monitored by




                                                                                                                            Related Class




                                                                                                                                                                                                                                        Workbased
                                                   11th-12th




                                                                                                                                                                  Attendance
                                                                                                                            Enrolled in
                                                                                            Agreement




                                                                                                                            Currently
                                                                         or LTCS




                                                                                                                                                                                                                                        Learning
                                                     only




                                                                                            Training




                                                                                                                                                                  Verified
                                                                                                                            Teacher




                                                                                                                                                                                                                                        Hours
                                                                                                         Plan
     Pupil Name                                     Grade      Hour
1. Smith, Michael (sample)                           11th      5th-6th      IDUW              Y               Y               Y       NA       Y                     Y         Y                     Y                    Y               Y       .30
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
I certify that this is a true and accurate list of pupils enrolled in State-Approved CTE Work-Based Education Programs.

Authorized Representative's Signature                                                                   Title of Authorized Representative                                                                         Date
                                                                                                                                           Genesee ISD/DH:hw/10-16-07/Pupil Accounting/Forms 07-08/Work Based

								
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