Cooperative Education--Student Training Agreement

Student Name: ______________________________ Telephone: ________________________
Student E-mail:________________________________________________________________
Address: ___________________________ City: ___________________State: ___ Zip: _____
Social Security Number:  _______________________ Date of Birth: _____________________
Employer Name: ____________________________ Telephone: ________________________
Employer E-mail: ______________________________________________________________
Employer Address: ____________________________________________________________
Days per week:    M  T  W  TH  F  S  SUN     Hours per day: _________ Hours: _______ a.m./p.m.
Training/Occupation Title: _______________________________________________________
Release Periods: ______________________________________________________________
Career Clusters 
(Circle the one that applies)

Agriculture, Food & Natural Resources 	Health Science 	
Architecture & Construction	Hospitality & Tourism 	
Arts, A/V Technology & Communication 	Human Services	
Business, Management & Administration	Information Technology	
Education & Training 	Law, Public Safety & Security	
Energy 	Manufacturing 	
Engineering & Technology Education 	Marketing, Sales & Service	
Finance 	Science, Technology, Engineering & Mathematics (STEM) 	
Government & Public Administration 	Transportation, Distribution & Logistics	
Work-based Learning Activity
(Check all that apply)

•	Clinical/Practicum	 Job Shadowing	  School Enterprise	   Internship
•	 Mentoring      Youth Apprenticeship	  On-the-Job Training
EMPLOYER RESPONSIBILITIES:  The employer agrees to place 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 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 handicap.
TEACHER/COORDINATOR RESPONSIBILITIES:  The teacher/coordinator agrees to visit each trainee at the training station and will continue 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 meet with each trainee’s parent and/or guardian prior to job placement and during the school year.  The local education office will keep each trainee’s Training Agreement on file for three (3) years.
PARENT/GUARDIAN RESPONSIBILITIES:  The parent/guardian agrees to allow the student to participate in the program as provided by the public school.
STUDENT RESPONSIBILITIES:  The trainee (student) agrees to follow rules and guidelines established by the school, employer, and teacher/coordinator with regard to hours of work, school attendance, and reporting procedures.
ALL SIGNATORIES AGREE TO COMPLY WITH THE RESPONSIBILITIES SPECIFIED IN THE TRAINING AGREEMENT.

___________________________ _________	_______________________ ___________
Student				Date		Teacher/Coordinator		Date

___________________________ _________ 	_______________________ ___________
Employer			            Date		Parent/Guardian		Date

____________________________________________________________________________
Employer’s Insurance Carrier
____________________________________          ___________________________________
Carrier’s Contact Person				Telephone