Intern Application (Page 2 of 3) in pdf

Intern Application Page 2

South Bend Community School Corporation

Special Education Services

INTERN Program

Student Training Agreement

School:

Date:

2/25/0205

Wonderful High School

Student ID#:

Name:

Phone:

170426

Bloggs, Bert

574/234-1752

Address:

City:

State:

Zip Code:

1704 Virginia Avenue

South Bend

46628

The goal of students participating in the INTERN program is to provide them with the opportunity to acquire job

skills in realistic work environments;

1. The SBCSC employee/Teacher of Record will review the types of training available and job

requirements with the student.

2. The student will not displace or replace paid employees.

3. Training in any one position will not exceed one semester.

4. Specific objectives and skills will be included in the Individual Educational Plan for the student.

5. The student will not be financially compensated for this training experience.

6. There is no promise of paid employment being offered at the conclusion of the training.

7. The establishment supervisor will participate with SBCSC employees in student evaluations.

8. Supervision of the student will be scheduled and determined by the school in cooperation with the

establishment supervisor.

9. A copy of this agreement will be provided to the establishment supervisor, SBCSC employee parent

and the student.

___I understand that my child's picture may be taken and used in the preparation of his/her portfolio page, for

use in presentations about the SBCSC's INTERN Program, or in brochures or other publications prepared for

the purpose of staff training and informing the public about the services of the South Bend Community School

Corporation.

___I understand that certain training opportunities with the INTERN Program (positions at health care facilities &

some child care training sites) require screening for tuberculosis. I authorize this screening be given at no cost to

me.

I give my permission for

to participate in community based INTERN

training as described above. I understand that this is an ongoing part of my student's IEP.

Parent/Guardian signature

Date:

2/25/0205

Permission granted covers the current school year. Thank you for your cooperation.

SBCSC IEP Effective Dates:

INTERN Training Positions

Intern Application Page 2

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