ENROLLMENT APPLICATION

Class #
ENROLLMENT APPLICATION
Course Enrollment

CE100 - Occupational Work Experience
Student First Name*
Middle
Student Last Name*
SMHS ID #:
Grade
Date of Birth*

MonthDayYear
MaleFemaleOther
Address*

Home Mailing Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Zip*
Telephone*
Contact number you can be reached at
Palomar I.D. Number*
SMUSD Email
example@example.com
E-mail Address (one you check REGULARLY)*
Please use an email address you check REGULARLY - Email address will be used for all Work Experience correspondence.
Parent/Guardian Email address
example@example.com
Employer's Company Name*
Where do you work?
Business Phone Number*
Please enter a valid phone number.
Business Street Address (Actual Location)*
City/ State*
Zip*
Your Employment Type:*

JobInternship
Your Position Type:*

PaidNon-Paid
Supervisor's Name*
Supervisor's Title*
Supervisor's Direct phone #*
Supervisor's Email address*
Employment / Internship Information Approximate hours per week you work*

5+ hours10+ hours15+ hours20+ hours30+ hours37.5+ hours
Your Position Title*
How long have you worked here*
What are your plans after High School?*
College Major
Which Branch?
What type of apprenticeship?
Occupational Goal: What career field are you thinking of going into?
Job Related Class (if applicable)
Are you taking any classes related to this career field?
Student Acknowledgment of required Employment/ Internship Hours: For Each unit of enrollment, the student MUST complete a minimum of 54 hours (total 162) to receive a passing grade.
Student Signature (Hand written or digital signature accepted)*

Clear
Date

MonthDayYear
Date
Instructor Name (Print)
Date

MonthDayYear
Date
Occupational Work Experience Education
3 units
Should be Empty: