Work Site Learning Plan

(Name of Site) will permit (name of student) from (name of school) High School to enter the workplace as an intern under the supervision of (name of supervisor) for the purpose of gaining knowledge and experience in the area of (area of learning/career) for approximately ( ) hours a week/day at ( ) dollars per hour.
The following work site learning plan provides a description of each component of the work experience:
Tasks student will perform:

Skills required:

Work environment (schedule of rotation through major departments):

Work processes, technology, and equipment student will use or observe:

Safety precautions:

Dress code and behavior:

Additional comments:

Student's Signature: ______________________________ Date: ______________
Employer's Signature: _____________________________ Date: ______________
Coordinator's Signature: ___________________________ Date: ______________
Parent's Signature: _______________________________ Date: ______________