Name: Mobile Phone #: 2021-22 DCT Forms

Name: ___________________________

Mobile Phone #:___________________________

2021-22 DCT Forms Mrs. Heather Renfroe, DCT Coordinator

850-748-2226

STUDENT CHECK LIST

Please check and make sure you have the following forms completed. If you did

not complete and the forms before May 1, they must be completed and returned

to me by Friday, August 27.

Failure to check and turn in your forms will remove you from the DCT and/or

OJT class(es).

Student application for DCT/OJT with four teacher references, etc.

Syllabus, Course Outline & DCT Guidelines read & signed by student and

parent/guardian

Form K: Authorization for Student Participation in a School Work-Based

Learning Program signed by parent and two witnesses.

Authorization for Student Participation in Off-Campus Activity signed and

notarized.

Signed Training Plan Worksheet (signed by Employer & Student)

Signed Training Agreement (signed by Student, Teacher, Parent/Guardian

& Employer)

Copy of student’s valid driver’s license

Copy of automobile insurance card

Copy of medical insurance card if applicable

Check for $30 fee –covers field trips, club membership, etc.

Diversified Career

Training & OJT

Gulf Breeze High School

Student Application

2021-2022 Instructor: Heather Renfroe

[email protected]

Please Print Name ____________________________________________________________________________________

Address _________________________________________City _________________________Zip _________

Phone ________________ Cell ______________Birth Date ____________________________ Age ________

FL Driver’s License # ____________________________

Auto Insurance Co. _____________________________Policy # _____________________________________

Name of Father/Guardian ___________________________________ Cell Phone ___________________

Name of Mother/Guardian __________________________________ Cell Phone ___________________

With whom do you live? ____________________________________________________________________

List any medical problems that could affect your job performance. ___________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

Have you been arrested? ________ If so, please state details. _______________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

Are you presently working? Yes ______ No _____ If so, how many hours per week? ____________________

If yes, where? ____________________________ Beginning Employment Date _______________________

Supervisor’s Name ______________________________ Phone _____________________________________

Business Address _________________________________________________________

_________________________________________________________

Duties ____________________________________________________________________________________

What is your normal work schedule? M-F ______ Saturday _____ Sunday _____ AM______ PM _____

Why do you want to enroll in the DCT program?__________________________________________________

__________________________________________________________________________________________

What is your long-term career interest? __________________________________________________________

__________________________________________________________________________________________

What are your plans after high school graduation? _________________________________________________

__________________________________________________________________________________________

Please note: I understand the concept of the DCT program, and I give my permission for the above student to enroll and

participate. I further understand that the parent/guardian assumes full responsibility for the student’s safety and conduct

from the time the student leaves school and arrives at his/her job and from the time the student leaves the job and arrives at

home. Student must have their own transportation to place of employment.

________________________________________ ____________________________________

Student Signature Date Parent/Guardian Signature Date

(OVER)

mailto:[email protected]


Teacher References (Four Required)

Please have four teachers’ sign that they would recommend you for the School to Work Program, DCT.

_________________________________________ _________________________________________

_________________________________________ _________________________________________

Current 2020-2021 Schedule Period Teacher Room

1

2

3

4

5

6

****Please have the appropriate office complete the information below.****

You will be called for an interview with Mrs. Renfroe during April or May. Please dress appropriately on the day of your interview. You may be requested to

come in from as early as 7:45 a.m. or immediately after school.

Interview date: _____________________

Comments: _____________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

Student Services

Total to Date Absences ________ Total to Date Referrals ________

Total to Date Check In _______Out_______ Suspensions ______

Comments:

________________________(Date)_______

Signature

Guidance Counselor ________________ GPA _________ 18 Credit Option? Y N

Comments:

__________________________ Guidance Signature

Next Year’s Schedule If there is a choice of OJT periods, which would you prefer?

Please circle one, two or three periods for work/early release.

1 OJT Period 2 OJT Periods 3 OJT Periods Only available for students

that have completed DCT Principles

The student understands that the work requirement is 10 hours per week for each OJT period and

that the student MUST work during the OJT period(s) to remain in the program. A student

may NOT work weekends only and be enrolled in OJT and

may NOT work more than 30 hour per week, including weekends.

**There is a $30 lab fee for enrolling in the DCT/OJT program** You may attach a check to this

application or use our school’s online method via MySchoolBucks.com

Diversified Career Technology Program Diversified Career Technology Principles 8303010 Diversified Career Technology Applications 8303020 Diversified Career Technology Management 8303030 DCT/OJT 8300410 Instructor: Heather Renfroe Email: [email protected] Phone: (850) 916-4179 These courses are designed to enable students to demonstrate employability skills; environmental, health & safety, professional, legal and ethical responsibilities; financial skills, leadership skills, communication skills; human resources and labor skills; America’s economic principles; entrepreneurship principles; relate planning methods to life/career goals and use of industry/technology principles in life and in the workplace. There will be various assignments associated with these courses. Some of the assignments are projects using various applications that may be lengthy in nature and will require work outside of the classroom. A notebook will be kept by each student and should be brought to class each day. Students will be asked to participate in discussions and work on teams to complete projects. Work ethics and communication skills will be practiced on a daily basis. Membership in a class club is required and will have service opportunities and social activities. Objectives:

• Practice quality performance in the learning environment and the workplace

• Incorporate business techniques to enhance workplace performance

• Apply knowledge of information systems and use technology to enhance communication skills

• Learn financial planning strategies for situations in life and in the workplace

• Perform workplace function in an appropriate manner

• Explore career planning and opportunities for employment

• Maintain time cards and monthly evaluations (OJT) Evaluation: Grades will be derived from tests, quizzes, daily class assignments, presentations and projects. OJT students will be graded based on their attendance, work performance and their employer evaluations. Focus Parent Portal: Tests/Projects=50%, Class Assignments=40% and Participation=10% of the student’s nine weeks grade. GBHS has 24/7 access to student’s grades, performance, and attendance via our Focus Parent Portal which is accessed via our school website (http://www.gulfbreezehighschool.com/ ). If you have technical difficulties, contact Angel Humphrey at 850-916-4129. Classroom Policies:

❖ Students are expected to be in their assignment seat with all required maters and supplies each day and ready to work when the tardy bell rings

❖ When using the computer, log on with your own name and password; do no give your password to anyone else. No downloading or changing any of the computer settings is allowed.

❖ No gum, food, or drink is permitted in the classroom. It is a lab with expensive equipment. ❖ Students are to remain seated until the instructor dismisses class. The bell does not dismiss the

class. ❖ Students are responsible for all makeup work. Announced assignments/tests/quizzes/projects

are due as scheduled.

Lab Fee

$30



Diversified Career Technology Program Diversified Career Technology Principles 8303010 Instructor/Coordinator: Heather Renfroe Diversified Career Technology Applications 8303020 Telephone: (850) 916-4179 Diversified Career Technology Management 8303030 Email: [email protected] DCT/OJT 8300410

DCT/OJT Guidelines

1. Participation in all DCT/OJT activities is required unless prior approval is given by the DCT coordinator.

2. If you are absent from school, you MAY NOT work that day. 3. If you do not turn in your timecard on time, your timecard grade drops 10 points per day late.

There are no exceptions. 4. All students must be employed at all times. If you leave one job, you must have already secured

another. 5. If you leave a job without notifying the DCT Coordinator before you leave, your grade will

automatically drop a letter grade for the entire nine weeks period. 6. If you leave a job, you MUST submit a Letter of Resignation notifying your employer that you are

leaving and when your last day of work will be. A copy must be provided to your instructor. 7. If you are suspended from school for any reason, you are to notify the DCT Coordinator

immediately and you are subject to removal from DCT and placed on a regular school day schedule. If you do not attend school, you may not work at your place of employment.

8. If you are unemployed at the beginning of the school year or at any time, you must be continuously searching for a job and must keep the coordinator informed of all applications being submitted, complete the “Searching for a Job” form, and turn in a business card from the locations where you have submitted applications.

9. If you become unemployed, you have 10 days to find a job. While you are unemployed, you are to remain at school for all of your OJT periods under the supervision of the DCT Coordinator.

10. If you are FIRED, you may be dropped from DCT/OJT and your grade will be immediately affected. You may be placed on a regular school day schedule.

I have read the contents of the DCT/OJT Course Guidelines and Syllabus and will adhere to the rules and policies described therein. As stated in the curriculum guide, the course fee is $40 and is due at this time. The fee covers classroom and club membership expenses. Parents/Guardians: Please check below for your son/daughter to have permission to view PG/PG13 rated videos, which have been selected to enhance the Florida State Student Performance Objectives and Standards. Also, the application for DCT/OJT included permission for your student to leave campus for employment related issues (except to look for/apply for jobs). You signature below also acknowledges your permission. ________________________ Date_________ _______________________ Date_________ Student Signature Parent/Guardian Signature ________________________ _______________________ Student Phone Parent/Guardian Phone ________________________ _______________________ Student email Parent/Guardian email PG/PG13 Videos Yes__________ No__________



Form K – Work-Based Learning Program Authorization for Student

School Name:

Student Name: Date of Birth:

Home Address: Home Phone:

Name of Parent/Guardian: Relationship:

Address (if different from above):

Home Phone: Work Phone: Cell Phone:

Email address:

You, the student, are or Your student, if under 18, is enrolled in a School Work-Based Learning

Program this year. As part of this instructional program activities and/or training will take place in some

business establishments in the community, on a school approved field trip, or a workshop. You or Your

student will probably need transportation to be able to complete these requirements. The workplace

program may require students to drive to and from the work site, drive as part of their duties at the job site

or ride with other students.

A. Vehicle Insurance and Transportation Permission

Please check all modes of transportation you are/your child is permitted to use for this program.

☐Ride school bus

☐Drive vehicle*

☐Drive vehicle and carry student passengers (also complete Forms E and F)*

☐Ride in a vehicle driven by an adult

☐Ride in a vehicle driven by another student

☐Ride a bicycle

☐Walk

☐*Copy of valid driver’s license attached

☐*Copy of automobile insurance card attached

B. Medical Information and Authorization for Treatment

☐I or My student has medical insurance coverage (front & back of card attached)

☐I or My student does not currently have medical insurance coverage. I will purchase “student

insurance” coverage for my myself/my student.

Medical condition of student: ☐Excellent ☐Good ☐Fair

Comments:

Do you or your student currently take any medication? ☐Yes ☐No

Is there an allergy to any medication? ☐Yes ☐No

Name of Family Physician:

Phone Number: Physician Address:

Santa Rosa County District Schools

SR902420

Participation

Should a medical emergency arise while my student is participating in a program activity, I will be

notified at the above numbers in order to approve medical treatment. In the event that I or one of the

emergency contacts listed below cannot be reached, I give permission for immediate treatment as

required in the judgment of the attending physician.

Emergency Contact: Phone Number:

Emergency Contact: Phone Number:

C. Adult Student/Parent Permission, General Release and Waiver

I give permission for my student to participate in the School Work Based Learning Program and

its associated off-campus activities. By signing this form I specifically and with full knowledge

of the legal aspects of my agreement, herein for myself and the student named, do hereby agree

to the following:

• I agree that neither the Santa Rosa County School District (SRCSD) nor any employee or

agent of the district has assured me, or warranted or guaranteed to me, the abilities,

qualifications, or experience of the person or persons to be operating the motor vehicle in

which the student will be transported, and that neither the SRCSD board members, or any

employee or agent of the district shall be liable for any injury to, or the death of the said

student resulting from negligence of any person while the student is operating or is a

passenger in a motor vehicle.

• I agree that the risk of loss of any damages for personal injury or death of the student should

be shifted from the SRCSD, school board members, district employees and agents, to an

insurance carrier. I further agree that as a minimum, I will obtain student insurance coverage

or other insurance coverage which specifically covers the student while an operator or a

passenger of a motor vehicle.

• I agree to release the SRCSD, school board members and its officials, officers and

employees, from liability for any and all claims of injury which might occur while my

student is participating in this School Work Based Learning Program.

• I agree that before signing this agreement I had the opportunity to consult with and receive

advice from an attorney of my choice concerning the meaning and effect of this agreement

and my signature on this agreement. Furthermore, I agree that I had the opportunity to ask

questions and receive information from a SRCSB representative concerning the Work Based

Learning Program and the activities to be conducted during the program.

• I understand this is not a required program at this school and that the named student will not

be permitted to participate in this program without this authorization, permission, general

release and waiver.

Parent/Guardian Printed Name & Signature Date

⁂ Form must contain two witness signatures verifying the student signature.

Witness Signature: ________________________ Printed Name ________________________

Witness Signature: ________________________ Printed Name ________________________


SR902420

Gulf Breeze High School

Diversified Career Technologies and On the Job Training STUDENT TRAINING PLAN WORKSHEET

School Name: _______________________________ Student Name: Date of Birth:

Phone Number: OJT Release Period(s):

Job Title:

Company Name:

Company Address:

City: State: Zip Code:

Name of Supervisor: Telephone No.:

A. Specific tasks: list specific tasks for On-the-Job employment to be learned:

B. General tasks/employability skills needed for success for On-The-Job training:• Maintain neat, attractive personal appearance with good posture.• Maintain clean, well-pressed clothes and specific clothes (if required)• Exhibit a cheerful, positive attitude and professional manner• Demonstrate an understanding f the company’s vision and goals• Demonstrate an understanding of the company’s products and/or services• Demonstrate interpersonal skills which enhance team productivity• Demonstrate the ability to resolve customer, employee/employer issues• Demonstrate legal and ethical behavior within the scope of job responsibilities• Exhibit behavior supporting and promoting cultural and ethnic diversity• Follow policies affecting health, safety, and wellbeing of all workplace members• Display acceptable level of production and quality control• Demonstrate acceptable work habits and conduct as defined by company policy• Exhibit effective workplace safety practices including use of protective devices.

C. List the company’s vision and goals and what the company does: list how you fit into thecompany’s vision and goals.

The purpose of this cooperative education program is to provide the student with selected occupational skills through employment-related instruction and concurrent, paid, supervised on-the-job training. Employment-related instruction is in-school instruction, which includes competencies directly related to the occupation in which the student is employed. Supervised on-the-job training provides opportunities for selective placement based on the student’s occupational choice, competency development, and evaluation through planned instructional activities in a job setting. We agree that the tasks, duties, and/or competencies identified above are to be included in the student’s on-the-job training while enrolled in this program.

Signature of Employer: Date:

Signature of Student: Date:


SR900813

Diversified Career Technologies and On the Job Training STUDENT TRAINING AGREEMENT

School Name: _______________________________

It is understood that ______________________________________________________________________ (Student’s First Name) (Middle Name) (Last Name)

of _______________________________________________________________________________________ (Home Address) (City, State) (Zip Code)

is employed as a ______________________________ at _______________________________________ (Student’s Job Title) (Name of Business)

Business Address:_________________________________________________________________________ (Street Address) (City, State) (Zip Code)

Business Telephone: ________________________

Student may work during school hours beginning at ______ a.m./p.m when school is in session. Student must not work past 11:00 p.m. on days preceding school days. Students scheduled 4 hours or more must have a 30 minute break every 4 hours. Other restrictions: ________________ __________________________________________________________________________________________

Type of Business: (Circle Response) Food Service Retail Office/Administrative Childcare Other ____________________

Number of sections of On the Job Training student is currently enrolled in: __________ 1 = (5 hours per week) 2 = (10 hours per week) 3 = (15 hours per week)

************PLEASE READ THE FOLLOWING RESPONSIBILITIES CAREFULLY BEFORE SIGNING*****************

EMPLOYER RESPONSIBILITIES: Hour Requirement - By signing this agreement, the employer understands the student is enrolled in a school-based workforce education program and is not only working to receive hourly pay in accordance to state and federal regulations but is also receiving academic credit for such and therefore requires a minimum number of weekly hours as determined by the Florida Department of Education (5 per week if registered in one section of On the Job Training or 10 if enrolled in 2 sections and 15 if 3). The employer agrees to ensure the student worker is scheduled for the specified number of hours at a minimum and to contact the workforce education instructor if this agreement is compromised. Work Environment - The employer agrees to employ the trainee in the work specified above for the purpose of providing occupational experience of instructional value. The work activity will be under the supervision of a qualified supervisor. The work will be performed under safe and hazard-free conditions. The student trainee will receive the same consideration given other employees with regard to safety, health, social security, general work conditions and other policies and procedures of the firm. The employer will adhere to all state and federal regulations regarding employment, Child Labor Laws, and minimum wage, and will not discriminate in employment policies, educational programs or activities for reasons of race, sex, color, religion, national origin, marital status, age or disability.


SR900812

TEACHER/COORDINATOR RESPONSIBILITES: The teacher/coordinator agrees to visit each student trainee at his/her training station no less than one time per grading period (9 weeks) and will maintain a close working relationship with the person to whom the trainee is responsible while on the job. The teacher/coordinator shall attempt to resolve any complaints through the cooperative efforts of all parties concerned. The teacher/coordinator will maintain open lines of communication with the student trainee’s parent/s or guardian/s during the school year and will also ensure all required paperwork is collected and maintained on behalf of the student. The Training Agreement will be kept on file for (5) five years at the school center.

PARENT/GUARDIAN RESPONSIBLITES: The parent/guardian agrees that the student trainee may participate in Cooperative Education Training Program as provided by ____________ High School and will provide necessary documentation allowing student to leave the _____________ High School campus during regular school hours for employment and DCT class purposes. The parent/guardian is also aware that the student/trainee’s DCT/OJT grade is contingent upon his/her employment status, completion of weekly employment hour requirements, as well as attendance in Diversified Career Technologies (DCT) class.

STUDENT RESPONSIBILITIES: The student trainee agrees to follow the rules and guidelines established by the school, employer, and teacher/coordinator regarding hours of work, school attendance and procedures. The student trainee understands that classroom attendance is required, and appropriate behavior is to be maintained (in ALL academic classes as well as the workplace) - in order to maintain good standing in this program. Failure to maintain employment and/or appropriate academic standing can result in removal from the DCT/OJT program. It is further understood that if a student is not well enough to attend school, he/she is not well enough to attend work. Absences/Attendance, as well as appropriate and accurate documentation of active employment hours will be directly reflected in the overall grade for the DCT and OJT classes. The student understands the High School/Santa Rosa County Attendance Policies as outlined in the Student Handbook and Code of Conduct and agrees to handle absences accordingly.

WE, THE UNDERSIGNED, have read ALL components of this Training Agreement and understand and agree to the conditions and provisions contained therein.

________________________________ ________________________________ ____________ Student Name Student Signature Date

________________________________ ________________________________ ____________ Teacher Name Teacher Signature Date

________________________________ ________________________________ ____________ Parent Name Parent Signature Date

_______________________________ ________________________________ ____________ Employer Name Employer Signature Date

Employer Contact Information:

Email: ________________________________________ Telephone No: ____________________________

Address: _________________________________________ City: ______________ State: ______ Zip: _________


SR900812

Santa Rosa County School District Diversified Career Technologies and On the Job Training

Job Search Log for:

Date Time Business Contact Comments Call Back Hired

** If a student becomes unemployed, they must begin looking for a job immediately, documenting it on this log. Should the student remain unemployed for a two week period, they must be removed from the OJT course.**

Name: Mobile Phone #: 2021-22 DCT Forms

Documents

Transcript of Name: Mobile Phone #: 2021-22 DCT Forms