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.*

Yes
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)*

Yes

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

	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