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Community Based Learning Experiences (Forms)

 


REQUIRED FORMS CHART

Agreements are provided for each type of Community Based Learning Experience. 

Select and complete the correct agreement and forms.

STUDENTS & PARENTS

509J STAFF OR VOLUNTEER (business owner, supervisor)

COMMUNITY PLACEMENT

REQUIRED FORMS & AGREEMENTS

REQUIRED FORMS

ADDITIONAL FORMS

CAREER SHADOW

· Career Shadow Experience Instructions

·  Parent/Guardian Responsibility Agreement, Authorization Form

·  Career Shadow Planning Guide

·  Student Responsibility Agreement

·  Career Shadow Sample Questions

·  Career Shadow Reflection Sheet

·  Career Shadow Evaluation of Student

·  Sample Thank You Letter

·  Career Shadow Experience Instructions

·  Parent/Guardian Responsibility Agreement, Authorization Form

·  Career Shadow Evaluation of Student

·  Volunteer Application and/or copy of current Certificate of Insurance

·  Information for Local Businesses

If Business or Volunteer is concerned about their liability, they can complete the following forms:

·  Criminal History Verification Form

·  Volunteer Application

·  Risk Management Assessment

SERVICE-LEARNING

(When a 509J Staff Member is NOT Present at the Volunteer Site)

·  Student Pre-Project Worksheet

·  Confidentiality Agreement

·  Community Based Learning Parent/Guardian Authorization

·  Vehicle Transportation Permission Form

·  Vehicle Transportation Permission Form (Writable version)

·  Post-Project Student Report: Service Learning

·  Community Based Learning Experience  Student Reflection

·  Student Service Hours Log

·  Student Services Record

·  Any forms or training required by the Community volunteer or organization

·  Criminal History Verification

·  Confidentiality Agreement

·  Volunteer Application and/or copy of current Certificate of Insurance

·  Information for Local Businesses

·  Post-Project Teacher Report:  Service Learning

·  Community Based Learning Parent/Guardian Authorization

·  Reporting Log for Workers’ Compensation Coverage

·  Teacher Pre-Project Work Sheet (optional)

·  Permission for Use of Private Vehicle

·  Permission for Use of Private Vehicle (Writable version)

·  Risk Management Assessment

INTERNSHIPS

(Non-Paid)

·  Internship Experience Course Requirements

·  Internship Portfolio Assignment

·  High School Internship Learning Contract

·  Community Based Learning  Parent/Guardian Authorization

·  Vehicle Transportation Permission Form

·  Vehicle Transportation Permission Form (Writable version)

·  Resume Assignment On-line Directions

·  Cover Letter Worksheet

·  Exploring an Occupation on the Career Information System

·  Sexual Harassment Report

·  Sexual Harassment Flyer

·  Internship Experience:  Evaluation Form

·  Sample thank You Letter

·  Criminal History Verification

·  Volunteer Application and/or copy of current Certificate of Insurance

·  High School Internship Learning Contract

·  Community Based Learning Parent/Guardian Authorization

·  Information for Local Businesses

·  Permission for Use of Private Vehicle Form.   (REQUIRED ONLY IF VOLUNTEER/STAFF WILL BE TRANSPORTING STUDENTS.)

·  Permission for Use of Private Vehicle (Writable version)

·  Internship Experience Evaluation Form

·  Reporting Log for Workers’ Compensation Coverage

·  Permission for Use of Private Vehicle Form.   (REQUIRED ONLY IF VOLUNTEER/STAFF WILL BE TRANSPORTING STUDENTS.)

·  Permission for Use of Private Vehicle (Writable version)

·  Risk Management Assessment

STRUCTURED WORK EXPERIENCE

(Paid)

·  SWE Course Requirements

·  SWE Portfolio Assignment

·  SWE Learning Plan

·  Community Based Learning Parent/Guardian Authorization

·  Vehicle Transportation Permission Form

·  Vehicle Transportation Permission Form (Writable version)

·  Resume Assignment On-Line Directions

·  Cover Letter Worksheet

·  Exploring an Occupation on the Career Information System

·  Sexual Harassment Report

·  Sexual Harassment Flyer

·  Related Reading Report

·  SWE Self-Assessment

·  SWE Evaluation Form

·  Structured Work Experience Evaluation Form

Use these forms if 509J is assisting in the job placement:

·  Criminal History Verification

·  Community Based Learning Parent/Guardian Authorization

·  Information for Local Businesses

·  Permission for Use of Private Vehicle form. (REQUIRED ONLY IF VOLUNTEER/STAFF WILL BE TRANSPORTING STUDENTS)

·  Permission for Use of Private Vehicle (Writable version)

·  Copy of  current Certificate of Insurance

·  Risk Management Assessment

FIELD TRIPS

Community Based Learning Experience Field Trips

·  Field Trip Parent Permission Form

·  Follow field trip requirement as outlined in Board policy.

·  Follow Board policies for transporting students.

·  Teacher request form: Choose regular field trip request form or extended field trip request form depending on length of the trip

·  Risk Management Assessment

Contact Us

Crescent Valley High School
Career Learning Assistant
Phone:  541-757-5813
Staff:  Kathy Zimbrick

Corvallis High School
Career Learning Assistant 
Phone:  541-757-5799
Staff:  Donna Keim