2024-25 STUDENT - Work-Based Learning Internship Agreement

Student Name*

First NameLast Name

Email that you check regularly*

example@example.com

Phone Number where you can best be reached*

Area CodePhone Number

Internship Start Date (Use the first day of the semester if unsure) *

Date

Internship End Date (Use the last day of the semester if unsure)*

Date

Worksite Name/Location*

What days of the week do you work?*

What hours do you typically work?*

How many hours per week do you typically work? Remember, you must have 120 total hours over the course of the semester to gain a course credit for WBL.*

What is your supervisor's name?*

First NameLast Name

What is your supervisor's title? (ie. Owner, Manager, etc.)*

What is your supervisor's phone number where he/she can be reached?*

Area CodePhone Number

What is your supervisor's email address where he/she can be reached?*

example@example.com

In what program at FDJTC will you become a completer upon graduation? Please check all that apply.*

Is this internship placement aligned to your IGP? In other words, does your major that you have listed on your IGP align with your FDJTC program area and what you'll be doing at this internship? If not, you'll need to see your counselor to adjust your IGP OR select another internship placement.*

YesNo

Is this internship paid or unpaid?*

PaidUnpaid

Are you receiving a course credit at school for this internship?*

Yes. This internship is displayed on my course schedule or will be if not already and I am receiving a course credit. I understand that I must work 120 hours or more over the course of the semester in order to receive the course credit.No. I am doing this internship on my own time. I understand that I must work 40 hours or more over the course of the semester to receive credit for the internship. I also understand that I am NOT receiving a course credit for this internship.

General Requirements

CREDIT: The following MUST OCCUR for the student to receive credit for the work-based learning experience:

Student works a minimum of 120 total hours per semester to receive a Carnegie course credit or 40 hours to receive state accountability credit.
The student turns in all time sheets and other paperwork on time.
The employer completes evaluations each grading period (two per semester).
PROVISIONS FOR TERMINATION: This agreement may be terminated for any of the following reasons:

Non-performance on part of student and/or employer.
Relocation of student and/or employer.
Change in student’s career choice.
Other reasons such as conviction of a crime, non-attendance of school and/or work, not calling employer as far in advance as possible prior to work absence, or other reasons deemed appropriate by the administration and/or employer.
Responsibilities

THE STUDENT WILL:

Be at least 16 years old and at least Sophomore status.
Be responsible for their own transportation.
Maintain regular attendance at the work-site.
Maintain good grades, attendance and discipline at school.
Communicate openly with the WBL Coordinator if conditions interfere with progress at school.
Notify WBL Coordinator prior to resigning from internship position.
Turn in all paperwork, including training agreement, time sheets and evaluations, on time.
Attend all required WBL meetings.
Understand that quitting will result in being dropped from the WBL program and a grade of withdrawal failing (WF).
Understand that being fired will result in being dropped from the WBL program and a grade of F.

THE EMPLOYER WILL:

Appoint a training supervisor for the student and facilitate the training.
If internship is paid, pay the student at least current minimum wage, sign student’s time reports and conform with all local, state and federal laws.
Assess the student’s progress via regular evaluations quarterly on forms provided by WBL Coordinator and provide the student with a variety of experiences.
Permit a school representative to visit the supervisor and student at the work site.
Notify the WBL Coordinator promptly with conditions or concerns regarding progress of the student, or upon termination.
Refrain from working student over 20 hours per week.

THE SCHOOL DISTRICT WILL:

Appoint a coordinator to assist the student and employer and provide guidance.
Monitor student progress at the training site.
Adjust class schedules where possible to accommodate the student/employer.
Provide Worker's Compensation Insurance.

THE PARENT WILL:

Notify the WBL Coordinator Immediately with conditions that are interfering with the student’s progress at school.
Notify the WBL Coordinator prior to student resigning from internship.

*York School District One does not discriminate on the basis on race, color, creed, national origin, sex, sexual orientation, religion, age, disability or other legally protected status in admission to, access to, or operations of its programs, services or activities. It does not discriminate in its hiring or employment practices.

Please sign below indicating that you agree to adhere to the conditions listed above.*

DateTime