2024-25 Work Based Learning Application
Please complete this form. Be sure to enter accurate information! Mrs. Parker will meet with each applicant for an informal interview. Be sure to tell the teachers you list as references to expect an email from Mrs. Parker with a recommendation form they will need to complete.
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Are you currently a WBL student (in the 2023-24 school year)? *
What grade will you be in during the 2024-25 School Year? *
Describe your career goal? Your career goal should address a specific type of work, job, and/or industry you believe you would like to pursue after graduation. If you don't know or don't have a career goal, WBL is probably not for you. Earning income, saving money,  or getting experience for the future is not a career goal. *
Describe how you believe WBL can help you work toward your career goal: *
Which classes have you successfully completed that relate to the career goal you identified above (check all that apply): *
Required
Are you presently employed? *
If you are employed or have a summer job lined up, please list where.
Where would you like to be placed (work) if you are accepted into the WBL program for the 2024-25 school year?
Which semester(s) would you like to participate in the WBL program for the 2024-25 school year? *
How many blocks/periods would you like to participate in WBL1st Semester? *
How many blocks/periods would you like to participate in WBL 2nd Semester? *
What is your date of birth? *
MM
/
DD
/
YYYY
Street Address *
City *
Zip Code *
What is YOUR cell phone number? (please use dashes, ex. 770-123-4567) *
What is your Home Phone number? (please use dashes, ex. 770-123-4567)
What is your personal non-school email address? Be sure this is an email that you check FREQUENTLY!                                         *
Please verify your email address (this entry should match the one entered above). *
What is your school email address? (it should end with @students.pickenscountyschools.org - there are no spaces between pickenscountyschools.org) *
Who do you live with? *
What is your mother's first and last name? (can also be your guardian) *
What is your mother's (or guardian) cell phone number? Ex. 770-XXX-XXXX (use dashes please) *
Mother's (or guardian) email address: *
What is your father's first and last name? (can also be an additional guardian)
What is your father's (or guardian) cell phone number? Ex. 770-XXX-XXXX (use dashes please)
Father's (or additional guardian) email address:
Do you currently have or will you have a driver's license before the beginning of the 2024-25 school year? *
Do you have transportation for the 2024-25 school year? *
List the first and last name of the 1st teacher you plan to ask to recommend you for WBL. *
List the first and last name of the 2nd teacher you plan to ask to recommend you for WBL. *
What are your immediate plans after High School? *
Are you a member of a Career Technical Student Organization (CTSO)? *
Required
What other programs are you planning to participate in for the 2024-25 school year? *
Required
Please list any sports or other extra-curricular activities you participate in:
How did you hear about WBL? (check all that apply) *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Pickens County School System. Report Abuse
Google Forms