Common Contracts
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Work Based Training Agreement & Training Plan Special EducationSeptember 14th, 2020
Student / Learner Information Student Name: Grade: Date of Birth: Home Phone: Address: City: State: MI Zip: Emergency Contact Name: Contact Phone #: District Information School District: School Building: Date(s) of Safety Instruction: Employer Information Employer Name: Supervisor Name: Employer Address: Employer Phone #: City: State: MI Zip Code: Worker’s Disability Carrier: Policy No: Liability Insurance Carrier: Policy No: Out of District Placement Information Type of Placement: Out-of-District Non-CTE Unpaid Special Education Work-Based Learning Experience Job / Position Title: Placement Begin Date: Placement End Date: Hours to be worked MON TUES WED THUR FRI SAT SUN Earliest Latest In District Placement Information In-District placements MUST be directly related to post-secondary career and employment goals and objectives in thepupils Transition Services Plan developed for special education services.
