Child Guidance Program

Complete application and collect two teach and return to Mrs. Warfield and must be
turned into room E127.
This class is designed to provide you the opportunity to make informed career choices,
determine education needs, develop employability knowledge and skills and acquire
marketable skills.
Name: ________________________________ ID #
_________________________________________ Current Grade level: ______ Birth Date:
________________ Age currently: ______________________ Home address:
_______________________________________ _______________________________

Do you have parental consent to participate in an unpaid, work based training

program? _______

Are you aware that this class is double blocked and meets every day, all year
for two class periods?
_________
Why do you want to be in the Education and Training Program?
______________________________________________________________________________________
_______ ______________________________________________________________________________

List extra-curricular activities you are involved in:

_______________________________________________________________________________
______________
______________________________________________________________________________

List volunteer opportunities you have been involved in:

______________________________________________________________________________
_______________________________________________________________________________
______________
______________________________________________________________________________

List your experience with children:

______________________________________________________________________________
______________________________________________________________________________________
_______ ______________________________________________________________________________

Do you have your own transportation? ____________________ If not, how

will you obtain a way off campus?
_____________________________________________________________________________
How did you hear about this program?
_____________________________________________________
Have you ever been assigned ISS or OSS?
___________________________________________________

PARENT OR GUARDIAN INFORMATION

FATHER: Name ___________________________________Occupation
_______________________
Home address ____________________________________ Home phone:
____________________ E-mail address ____________________________________ Cell phone:
____________________ MOTHER: Name ________________________________ Occupation
_______________________
Home address ____________________________________ Home phone:
____________________ E-mail address ____________________________________ Cell phone:
____________________

I have carefully completed all the blanks in this application. If this application is
accepted and I am enrolled in the program, I understand the following:

This class is a full year and is two periods long.

In this class you will be doing class work and projects in addition to
working at the training site.
You will be expected to wear the child guidance shirt everyday.
Membership and participation in FCCLA student organization are
expected.
All school rules and regulations are applicable while at school and at
the training site.
Regular attendance at the job site is required. If you are able to attend
school, you are able to work at the training site.

Attendance at the training site is not permitted when absent from

school.
Notification to the teacher-coordinator is required by 7:00am that the
students is unable to attend school and will not be available to work in the
Training site on that day. Failure to call will be reflected in your weekly grade.
Students placed in school suspension for disciplinary action will not be
permitted to report to the training site on that day.
If for any reason you are not able to work in the training site as a
requirement of this class, you will be removed from the Education and
Training Program and placed in another elective.

Signed: (student) _____________________________________________ Date ____________

Parent/Guardian _______________________________________________Date_____________
*** Return completed application and teacher recommendations to E127***