Job Shadow Forms

Work-Based Education Program

INTERNSHIP/ SHADOWING EXPERIENCE AGREEMENT

\for the unpaid training internship or shadowing position of:

Student: Parent:

Address: Telephone: Cell:

Start date of internship: End date of internship:

Daily/Weekly time schedule:

COOPERATING BUSINESS/ORGANIZATION:

Address: Business Phone:

FAX:

Cell:

Internship Site Supervisor:

This training is organized as an unpaid internship in alignment with federal interpretation of student internships as follows:

1. The extent to which the intern and the employer clearly understand that there is no expectation of compensation. Any promise of compensation, express or implied, suggests that the intern is an employee - and vice versa.

2. The extent to which the internship provides training that would be similar to that which would be given in an educational environment, including the clinical and other hands-on training provided by educational institutions.

3. The extent to which the internship is tied to the intern's formal education program by integrated coursework or the receipt of academic credit.

4. The extent to which the internship accommodates the intern's academic commitments by corresponding to the academic calendar.

5. The extent to which the internship's duration is limited to the period in which the internship provides the intern with beneficial learning.

6. The extent to which the intern's work complements, rather than displaces, the work of paid employees while providing significant educational benefits to the intern.

7. The extent to which the intern and the employer understand that the internship is conducted without entitlement to a paid job at the conclusion of the internship.

WORK-BASED EDUCATION PARTICIPANT RESPONSIBILITIES

Business/Organization

  • Provide supervised internship learning experiences as agreed upon and outlined in attached Internship Experience Plan.
  • Observe all state and federal laws and regulations pertaining to student-learners (and minors if applicable.)
  • Operate in accordance with Vermont and Federal regulation regarding anti-discrimination due to race, color, religion, national origin, gender, sexual orientation, ancestry, place of birth, age, or disability.
  • Enable Work-Based Learning Coordinator to make periodic visits to the internship site.
  • Participate in formal and informal evaluations of student performance and progress related to the components of the student’s training plan.

Student

  • Follow regulations that apply to employees and other interns while on the internship site.
  • Keep Work-Based Learning Coordinator informed of progress and/or concerns related to this internship. (No change in placement status is to take place without prior approval of the WBL Coordinator and internship site supervisor.)
  • Notify the employer and the Work-Based Learning Coordinator as soon as possible if unable to attend your internship placement’s established day/hours.
  • Attend all sessions of any required school courses.
  • Demonstrate a conscientious attitude toward both internship and in-school assignments. Complete all course requirements, maintaining a passing grade in technical program and all other courses.
  • Provide own transportation to and from Work-Based Learning internship site with a properly registered and insured vehicle.

Work-Based Learning Coordinator

  • Coordinate and prepare individual Work-Based Learning internship plan for student-learner in cooperation with employer representative(s).
  • Plan and coordinate educational program which integrates in-school and on-site learning experiences.
  • Ensure that accident insurance coverage is in place for student interns.
  • Make periodic visits to internship site to monitor student progress on the job and consult with internship site personnel.
  • Facilitate the evaluation of student training in the internship."

GOAL(s) & PRIMARY QUESTION(s)

Learning Goal(s):

Primary Question(s):

Reflect on goal(s) in relation to PLP:

21st CENTURY & AOE TRANSFERABLE SKILLS / GRADUATION PROFICIENCIES

SPECIFIC WORKPLACE & CAREER SKILLS

Checklist of Insurance(s) and supporting documents:

-- Include Evaluation Form

TERMINATION

Termination of this agreement may be initiated by any of the participants. The Work-Based Learning Coordinator is responsible for the transfer or withdrawal of the student-learner at any time after evaluation of the placement situation and consultation with employer.

Student Signature Date

Parent/Guardian Signature Date

Program Instructor Signature Date

Work-Based Learning Coordinator Signature Date

Employer Signature (& title) Date

** The Work-Based Learning Program operates in accordance with all federal and state laws and regulations regarding nondiscrimination of participants on the basis of age, race, color, national origin, gender, sexual orientation or disability.