Burke County Public Schools Internship/ Work-Based Learning Application

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please submit a COMPLETED application, answering all fields requested. USE APPROPRIATE CAPITALIZATION (Name, Address, etc.) AND CORRECT SPELLING. Write N/A when not applicable to you.

Last Name

First Name

Mailing Address:

Home Phone #

Cell Phone #

Student ID Number (lunch #)

Grade Level (2021 - 2022)

Requesting Internship which school term?

Summer 2021

Fall 2021

No internship credit request at this time

Clear selection

Birthdate

YYYY

High School

Burke Middle College

Draughn High

East Burke High

Hallyburton Academy

Freedom High

Patton High

Clear selection

School Email Address

Have you done previous job shadows or internships as a volunteer?

Have you ever been convicted of a misdemeanor or felony?*

Yes

If yes, please explain below

Clear selection

Explain Conviction

Have you ever been suspended from school?*

Yes

If yes, please explain below

Clear selection

Explain suspension

Will you have a job, sports, or other major commitments during the time you are requesting this program?

Yes

If yes, explain what may interfere

Clear selection

Explain Interference.

What means of transportation will you use to get to a work-based learning site? (If applicable)

Select the WBL program you are interested in* *

Internship - Paid (135 Hours work for one semester)

Internship - Unpaid (135 Hours work for one semester)

Job Shadow (no class credit awarded; all grade levels eligible)

Cooperative Education (must have enrolled in a CTE Class related to work-based learning, 11th and 12th)

Apprenticeship (300 required work hours for one semester, available to 11th, 12th)

Required

Explain why you would like to have an Internships and your future plans.

Interests: (check all that apply)

BCPS Food Service (Fall - Spring 2021-2022

Burke County Schools Bus Garage/Custodian (General Needs) (Paid)

Innovative Ink (paid)

Burke County School Technology Dept (paid)

Other:

Specific Company Internships Request

**Detail any work and school experience that you would like to share at this time.

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Burke County Public Schools. Report Abuse

Forms