2025 Rock Externship Application

2025 Rock Externship Application

Please complete the form below to apply for the Rock Externship. Please note that you must be currently employed in good standing with a school or school district within Rock County, WI.
Thank you for your interest in the 2025 Rock Externship. Applications for the externship will open in January 2025. If you have any questions please contact mmarkley4@blackhawk.edu.
Date

MonthDayYear
Date
Full Name*

First NameLast Name
School *
Email Address-Please use an email you regularly monitor during the summer. *
example@example.com
School Phone Number:*
Please enter a valid phone number.
Personal Phone Number:*
Please enter a valid phone number.
Please describe your role in the school district (e.g. administrator, counselor, support staff, teacher, other). In addition, please include any extracurricular activities or coaching that you do. *
How many years have you been employed in your current district?*
How many years have you been employed in education?*
Which career, career cluster and/or industry sector would be the most relevant to your area of expertise or interest? (Please select 2)*

Architecture and ConstructionArts, A/V Technology and CommunicationsAgriculture, Food, and Natural ResourcesBusiness Management and AdministrationEducation and TrainingFinanceGovernment and Public AdministrationHealth ScienceHospitality and TourismHuman ServicesInformation TechnologyLaw, Public Safety, CorrectionsManufacturingMarketingScience, Technology, Engineering and MathTransportation, Distribution and Logistics
If selected to participate in this program, how would you use this experience as an instructional tool? How would the information and data gleaned from this externship be incorporated into your content or curriculum during the 2025-2026 school year and beyond?*
Have you previously participated in the Rock Externship?*

YesNo
Please note that educators who have not yet participated in the Rock Externship receive priority when determining placements.
By signing below, you are confirming that all Information you have provided on this form, and all other related Rock Externship Program forms and/or materials is accurate, complete and truthful; and you certify that you have read and understand the program’s terms and conditions; and you agree to hold harmless the Intern Worksite Employer and/or its staff; Blackhawk Technical College and its Externship Coordination Team; and Rock County 5.0 and/or any of its member or partnering organizations, its contributors, independent contractors for all liability claims; for any direct or indirect damages, and/or outcomes associated with participation in this externship program. Furthermore you acknowledge that participation in this program will result in a tax form. You acknowledge that should you leave employment within the K-16 workforce in Rock County prior to September 1, 2025 you will be required to pay back your stipend. You further acknowledge that you are authorized to sign this Agreement; and understand this section shall continue beyond the expiration or termination of this Agreement.*

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