Step One-Inquire: Discuss your interest in Co-op with your counselor and/or see the co-op coordinator to discuss eligibility.

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1 Name: Work Based Learning (Co-op) Co-op Coordinator: Eric Meyers Lake Fenton High School Course Description: Work Based Learning (Co-op) Co-operative work based learning provides students the opportunity to earn high school credit and develop occupational skills for future employment in business or other related career and technical occupational areas. Qualified students spend part of their day in school and part on the job. The employer is considered a partner in the program by providing required documentation, training, work experience, and the possibility of continued employment upon graduation. Eligibility requirements as determined by The State of Michigan Department of Education apply. Basic Eligibility Requirements Job placement must align with the student s Educational Development Plan (EDP) Students chosen Career Pathway must match job placement At least 16 years of age, and junior or senior status Previous or concurrent completion of related CTE courses & good attendance record, dependable Enrollment in a co-op related class Employer must provide proof of Workers Compensation and Liability Insurance Student must supply a copy of a pay stub that shows taxes taken out Must work a minimum of 10 hours per week Students agree to participate in a paid WBL (Work Based Learning) experience Checklist of items that need to accompany this application: 1. Copy of transcript 2. Educational Development Plans (EDP) 3. Copy of recent pay stub 4. Enrollment in Co-op Classroom using the code: pmg9xd 5. Enrollment in Remind using the code: entering this number: Text the following Step One-Inquire: Discuss your interest in Co-op with your counselor and/or see the co-op coordinator to discuss eligibility. Step Two-Application Process: Read and complete this packet. You ll need information from your employer and approval from your parent/guardian. Submit the completed packet with a copy of your transcript to the co-op coordinator or to the counseling office. Once eligibility has been determined, a contract will be generated. Step Three-Work Training Agreement/Training Plan (WTA/TP): The Work Training Agreement is a legal contract between the student, parents, school district, and employer that details all the parameters of the student s employment, serves as the work permit, and establishes that youth labor laws apply. The Training Plan connects the student employment objectives to the Educational Development Plan (EDP) and student s career goals. The coordinator will generate the WTA/TP. The student will sign, obtain signatures from parent and employer, and return to the co-op coordinator. To be valid, signatures are required from the student, parent/guardian, employer, certified teacher, and the high school principal. Step Three-Initial Site Visit: Once the WTA/TP is signed, the coordinator will make an initial site visit to meet the employer, assure workplace safety, deliver their copy of the WTA/TP and answer any questions the employer may have. The WTA/TP must be in place and the site visit completed before you can leave during the school day for the job site or get any credit for hours worked.

2 Work Based Learning Co-op Application Co-op Coordinator: Eric Meyers Lake Fenton High School This is an application to be considered for enrollment in the Co-op program. Placement is not guaranteed as MI Dept. of Education eligibility requirements apply. Please complete all parts legibly and completely. Submit to Mr. Meyers in room B 113 before you can start your Co-op experience. Student Profile Student Name: Age DOB: Today s Date Address, City, State, Zip Home Phone: Student Cell # Grade in : 11 Grade 12 Grade Co-op Enrollment Desired: (check all that apply) 1st Semester 2nd Semester Emergency Contact: Relationship: Emergency Contact Home Phone: Cell # Educational Development Plan (EDP) The student s chosen career pathway, job placement, and related class must ALL be in the occupational areas of the pathway selected and match occupational goals. The EDP is an ongoing plan created and updated in Career Cruising. A printed EDP must be attached to this application. Career Pathway 1 st choice 2 nd choice Co-op Related Class Students must be concurrently enrolled in a Co-op job-related class. The Co-op Coordinator can assist you in determining which class is applicable to your placement. Requested Co-op Related Class (Be sure you have requested this on your schedule) Semester 1 Semester 2 Employment Status Currently Employed Business Name Address City, Zip Immediate Supervisor Phone Not Currently Employed (You will not be scheduled into Co-op until you obtain employment) Seeking Employment in: Business Office Medical Office Retail Sales Restaurant Customer Service Other *If currently employed, provide a copy of a recent pay stub with this application.

3 LFHS Co-op Student Contract/Expectations The Co-op student: 1. shall conform to all federal, state, and local labor laws and regulations. 2. Shall agree to a paid WBL experience; non-paid WBL s are not offered at Lake Fenton. 3. abide by all LFCS and LFHS rules and regulations. 4. must enroll in and pass a Co-op related instructional class. 5. complete required health and safety training provided by the employer and/or the coordinator. 6. agrees to check their school issued regularly as a means of communication with the coordinator. 7. must work a minimum of 10 hours per week. 8. work all scheduled hours including those on Saturdays, Sundays, and holiday vacations, if necessary. 9. agrees to submit completed weekly time logs by Wednesday at the end of the school day on due date. 10. will be placed on academic probation should he/she fail to turn in weekly time logs for 2 consecutive weeks. 11. understands failing to turn in weekly log sheets for 3or more consecutive weeks results in a failing grade. 12. will abide by the employer rules and regulations, including any dress and grooming requirements that the employer may deem desirable. 13. provide their own transportation to and from the job. Students shall not drive as part of their employment. 14. must always be supervised by an experienced adult. 15. agrees to keep the coordinator informed of all changes affecting his/her Co-op position. 16. must inform the coordinator in advance, and receive approval to terminate his/her work. If the Co-op student terminates his/her work without the knowledge and consent of the coordinator or if the student is fired with just cause by his/her employer, as determined by the coordinator, the student will fail the semester. 17. who is laid off from work, through no fault of their own, may take another job or must enroll for a full school schedule. 18. will not accept any employment in addition to his/her Co-op position without prior consent of the coordinator. 19. must remain at the same place of employment for the entire semester. They cannot change employment without the consent of the coordinator. 20. who is absent from school must call his/her employer each day of an absence. On days students do not attend school, students are NOT allowed to work unless prior permission has been granted by the coordinator. 21. who accumulates excessive absences from school may not be allowed to continue participation in the Co-op program and may be in jeopardy of losing credit. 22. understands that the granting of credit depends upon assignment completion, the satisfactory performance of duties, employer evaluations, coordinator evaluations, and accumulation of required hours worked. 23. must earn a final grade of at least 78% for 1 st semester to remain in the program for 2 nd semester. 24. will maintain passing grades in all classes, at all times. If class grades are not acceptable the student may be dropped from the Co-op program. Failure to comply with this agreement will be grounds for dismissal from the program and failure for the semester. The employment of the student will conform to all federal, state, and local laws and regulations, including those that: Prohibit discrimination against any applicant or employee because of race, age, sex, religion, marital status, national origin, ancestry or disability. Restricts both the hours of employment and type of occupations that minors can work in order to safeguard their well-being, health and safety, and progress in school. All Work Based Learning programs follow the district s policies of nondiscrimination as stated below. It shall continue to be the policy of the Lake Fenton Community Schools not to discriminate on the basis of religion, race, color, national origin, sex or handicap in educational programs, activities, or services and to comply with all requirements and regulations of the U.S. Department of Education. All students shall have an equal opportunity to participate in and benefit from, all academic and extra-curricular activities or services. The grievance procedures is as outlined in Title VI of the Civil Rights Act of 1974, Title IX of the Education Amendments of 1972, and /or Section 504 of the Rehabilitation Act of WE, THE UNDERSIGNED, HAVE READ AND AGREE TO ABIDE BY THE ABOVE LISTED REGULATIONS: Student Signature Date Parent/Guardian Signature Date

4 LFHS/Cooperative Education Program Driving Approval I give permission for to participate in the Co-op program at Lake Fenton High School. I fully understand that I am responsible for all transportation required to and from the job site. My son/daughter has my permission to drive from school to his/her place of employment. However, according to MI State law, he/she may not drive as part of their job duties. Student Signature Date Parent/Guardian Signature Date

5 Place of Employment: Co-op Position Details To be completed by the student and employer together. Business Address : (include zip) Supervisor s Name: Supervisor s Job Title: Student Name: Phone: Supervisor s Business Student s Job Title: Starting Wage Average Hours Per Day Date of Hire: Date Employment Ends: Hours Worked or estimated hour will work Monday Tuesday Wednesday Thursday Friday Saturday Sunday Earliest Latest Job Description: Essential Job Functions, Duties/Tasks Include detailed information to describe the co-op position. This information will be used along with basic employment competencies to determine the training plan for the co-op student, as required by the State of Michigan for Co-op placement. Sample: Provide Customer Service Greet customers upon arrival Assess customer needs and take orders Collect payment and provide receipt for order Employer Insurance Information (State Required) Worker s Compensation Carrier: Liability Insurance Carrier: Carrier Contact Name/Phone #: Carrier Contact Name/Phone #: Policy #: Policy #: