Work Based Learning Application Spring 2022

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You will need to use your CCBOE email to fill out this form....This is the first part of the enrollment process. A Training Agreement and 3 Teacher Recommendation Forms (You can pick these up at CATA or from your counsellor) will need to be completed, signed, and turned in to the WBL Coordinator, Mr. Riddle. Thank you

Are you considered 'on track' to graduate with your Senior Class? (Grades, Attendance, Discipline) *

YES

No - (WBL is not recommended for students who are failing behind in their academic coursework.)

What is your STUDENT Email? (1908765432@ccboe.org) *

Do you have access to internet and a device outside of school? (All course work is completed online via Google Classroom and Canvas) *

Yes

No (Please see your counselor or call Mr. Riddle at CATA)

First Name (please give your legal name) *

Last Name *

School *

Good Hope

West Point

Cold Springs

Holly Pond

Vinemont

Hanceville

Fairview

CDC

Grade *

11th

12th

Your Cell Number (xxx-xxx-xxxx) *

Parent/ Guardian name *

Parent/Guardian Phone Number *

What is your Career Objective Pathway *

Name of Training Station (Where you work) *

Training Station Address *

Supervisor Name *

Supervisor Phone Number *

Supervisor Email *

How long have you worked here? *

less than a month

1-3 months

3-6 months

6 months-1 year

1-2 years

3 or more years

Submit

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