Homebased CTE Rough Draft

Work Based Learning Form

Please complete for HBCTE approval.
Today's Date

MonthDayYear
Date
Teacher Name

First NameLast Name
Teachers Email
example@example.com
Name of program
Date of HBCTE

MonthDayYear
Date
You may add additional dates for HBCTE here. (All information on this form must be the same for all additional dates requested)
Reason for HBCTE: (Ex. field trip, low attendance, industry certification testing, NOCTI, remediation for small group, etc.)
Please check one. If ALL students WILL NOT be on HBCTE, list students by district in the next field
List all HBCTE students by FIRST AND LAST NAME by district.
My attendance will be submitted by 9:00 AM.
I understand that it is my responsibility to have HBCTE students contact their academic class teachers/sports coaches at sending schools and notify them of the date(s) they will be on HBCTE. (CMS classes, JB afternoon classes, sporting event)

Transportation/Cafeteria information for in-person students. *You DO NOT need to complete this if ALL students in your program will be homebased.

Rows	Number of in-person students needing transportation from sending school	Number of in-person students who will eat in cafeteria
CASD
FMSD
GASD
SASD
TASD
WASD

Work Based Learning Form