CWD - WBL - Work Based Learning Student Pre-Assessment Form

Student Pre-Assessment

Please complete this pre-assessment to give our Industry Engagement team more information regarding your work-based learning (WBL) interests.
Students need to meet the following requirements to participate in the work-based learning program:

- Hold a high school diploma or GED certificate
- Be actively enrolled in classes at CSM
- Maintain a 2.0+ GPA
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Email*
example@example.com
Date of Birth*

MonthDayYear
Are you Active Military/Veteran?*

YesNo
What is your current or intended program of study?*
What is your major?
How many courses have you taken in your major?
If you are a current CSM student or recent high school graduate, what is your GPA?
What is your career goal?
How many credits do you plan to take during your work-based learning experience?*
Can you add 15 or more hours of work to your current obligations?*
What skills are you hoping to gain or enhance as a part of the Work-Based Learning experience?*
Have you ever been employed before?
Do you receive Federal Work Study?*
Do you have a Work Study work site?
Please provide the site name or department:
How much are/were you being paid hourly?
Do you have reliable transportation?*
How many miles are you willing to travel for work?*

Under 10 miles11 - 20 miles21 - 30 miles31 miles or more
What days are you available to work?*
Use Ctrl to select multiples
What evenings are you available to work?*
Use Ctrl to select multiples
Are you certified as "work ready" through ACT WorkKeys National Career Readiness Certificate? (Certification is not a pre-requisite to participate in a WBL opportunity.)
Visit https://www.csmd.edu/programs-courses/non-credit/workforce-training/ncrc.html for information
Where did you first hear about Work-Based Learning?*

CSM WebsiteAdmissions ApplicationAdmissions StaffAdvising StaffCSM AlumniBusiness OwnerSocial MediaCSM FacultyCommunity OrganizationParentsCSM Staff MemberOther
If you are applying for a specific position that you have seen advertised, please list the position:
What are your plans following CSM? *
Upload your resume (optional) or email it separately to wbl@csmd.edu. CSM's Academic and Career Advising can assist with writing a resume advisor@csmd.edu or 301-934-7574

Cancelof
OFFICE USE ONLY: Coded in Colleague?

YesNoOther
OFFICE USE ONLY: Is the student eligible for a position?

YesNoStudent did not respond to outreachOther
OFFICE USE ONLY: Department Code
FOR OFFICE USE: Student Placed?
If yes, date that contract was sent to student.
FOR OFFICE USE: Location of Employment and Employment Dates
FOR OFFICE USE: Notes
Should be Empty: