Work Based Learning Form
Please complete for HBCTE approval.
Today's Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Teacher Name
*
First Name
Last Name
Teachers Email
*
example@example.com
Name of program
*
Please Select
Ag Mechanics
Allied Health
Animal Science
Auto Collision
Auto Tech
BCT
Carpentry
Cosmetology
Culinary
Dental Asst
Diesel
ECE
Electrical Occ
Electronics
Engineering
Graphics
HVAC
IST
Land & Hort
Machining Tech
Marketing
Mechatronics
Medical Assisting
Protective Services
Vet Assisting
Welding
Workforce Development
Date of HBCTE
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
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.
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
Submit
Should be Empty: