DOCUMENT CHECKSHEET
Student’s name: _________________________________ Student birthdate _______________
Program: _____________________ Worksite experience beginning _______ ending ________
Site: _______________________________ Address: _________________________________
Telephone: ________________________ __________________________________
Worksite supervisor name: __________________________ Title:_______________________
School Work-Based Learning Coordinator(s): ________________________________________
The following must be complete and on file for each student experience:
| Student Application (if required) | |
| Site Pre-qualification & Safety (documentation) | |
| Worksite Supervisor Orientation (documentation) | |
| Worksite Training Agreement | |
| Student “New Employee” Orientation (documentation) | |
| Student Worksite Learning Plans – COOPERATIVE WORK-BASED LEARNING experience requires a new plan every 180 hours | |
| Student Training/Work Time Documentation: | |
|
COOPERATIVE WORK-BASED LEARNING: Hour/Time & Wage Reports
OR Paycheck Stub Copies (documentation throughout; 360 hours per 1.0 credit) INSTRUCTIONAL: Time Report format determined by Worksite Supervisor and School Coordinator (documentation throughout; 180 hours per 1.0 credit) | |
| Coordination (Visitation & Evaluation) Documentation (Two per semester) | |
|
COOPERATIVE WORK-BASED LEARNING: 2 (two) per transcripted grading period
INSTRUCTIONAL: 1 (one) every 30 hours | |
| Student Evaluations involving Worksite Supervisor, School Coordinator and Student. | |
| Other _____________________________________________________________________ |
If student is placed in a cooperative work-based learning experience and is under the age of 18, Minor Work Regulations are in effect. The site must have a Minor Work Permit in place and the following are required. It is recommended that copies be included in the student file:
| Parent/School Authorization | |
| Student Variance forms (if applicable) |