Guntersville High School

Cooperative Education Application

 

Name________________________________________Telephone__________________

            Last                     First                         Middle

Address_______________________________Sex_______DOB__________ Age_____

City____________________AL_______Zip______Grade(2009/2010) _____________

 

Student’s Career Objective (MUST BE COMPLETED):

____________________________________________________

 

 

Career/Technical Education credits earned:

(MUST BE COMPLETED)

Includes Business/Marketing, Family & Consumer Sciences,

Technical Education and/or Marshall Technical School courses completed.

1.______________________________3.______________________________________

2._______________________________4.______________________________________

Student Agreement

I agree to participate in all aspects of the cooperative education program including:

  1. Be regular in attendance and on time at both the school site and workplace. I will notify my work site supervisor and school coordinator if under emergency situations, I am unable to attend work.
  2. Abide by all terms and conditions of regular employment at the work site and accept duties assigned by my supervisor.
  3. Adhere to all policies and regulations as set forth in the code of conduct by school administration and the co-op coordinator.
  4. Provide my own transportation to and from the work site and school site.
  5. Maintain a grade average 70 or above. (Failure to maintain average will result in being withdrawn from the program.)
  6. Represent myself in a manner that would that would reflect a positive image for Guntersville High School.
  7. Pay the required fees and provide proof of insurance coverage or purchase school insurance.

Date______________ Student Signature__________________________________

Parent Agreement:

I approve and agree that my son/daughter may enroll in the Guntersville High School cooperative education program and will cooperate with the coordinator, work site supervisor and school representatives in helping our student achieve success in a career objective.

Date______________ Parent Signature___________________________________

 

Verification of Medical Insurance Coverage

We, (I), the undersigned, hereby certify that we (I) are (am) either the parent of __________________________________, a student at Guntersville High School, or have legal custody of such student, or are (am) the adult person(s) having his (her) actual custody and providing parental like supervision and exercising parental like authority over said student; and do further certify that said student is covered by a medical insurance policy which is currently in force and which we (I) intend to keep in force for the remainder of the school year.

We (I) therefore request that said student be relieved of the requirement of taking medical insurance afforded through the school and which would otherwise be required in relation to his (her) participation in the Marketing Cooperative Education program.

Signature: ___________________________________ Date: ______________________

Insurance Name: ____________________________ Policy #: _____________________

 

 

 

______________________Do Not Complete Information Below This Line_______________________

To be completed by co-op coordinator

_____ GPA _____AHSGE

_____ Absences _____ Tardies

_____ Discipline Referrals _____Teacher Recommendations (3)

_____ Other

 

________ Approved

________ Not Approved________________

________ Pending_____________________

 

 

Co-op Criteria

CTE courses:

1.

2.

3.

Grade:

Career Objective:

Current Employment:

Advanced Co-op or Structured Work Study