Source: Debbie McClary, Kennewick School DistrictWORKSITE QUALIFICATION FORMCOMPANY NAME:EMPLOYER’S IRS IDENTIFICATION #ADDRESSCITY/STATE/ZIPHOURS OF OPERATION:WEB SITE: LEAD CONTACTPHONE:FAX: POTENTIAL DEPARTMENT FOR HOSTING STUDENTS1)5)2)6)3)7)4)8)AGE REQUIREMENTS OF STUDENTS# OF STUDENTS – HOSTING CAPACITY:QUALIFICATIONS – GENERALEVIDENCEIs there a Current Minor Worker Permit Posted? Will worksite Mentors be available to assist in the development of student’s learning objectives and communicate regularly with the Work-Based Learning Coordinator? If the worksite is a Private, For-Profit Organization, will there be opportunities for stud...
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