wbl coordinator site supervision form · internship program overview program description: an...

65850 Pierson Boulevard, Desert Hot Springs, CA 92240 (760) 288-7000 www.psadhshs.org

A California Partnership Academy, California Department of Education Revised 07/26/2020

Internship Handbook (Also used for off-campus Mentorships)

2020-2021

Career Technical Education Desert Hot Springs High School, Palm Springs Unified School District

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Table of Contents

Contact Information 2

Internship Program Overview 3

Internship Hosting & Dates 4

Intern’s Work Schedule 5

Public Services Knowledge & Performance Anchor Standards 6

How Interns Will Be Graded 7

Internship Mid-Term & Final Presentation 8

Internship Student Contract 9

Internship Parent/Guardian Contract 10

Intern’s Orientation Checklist 11

Intern’s Worksite Evaluation 12

Reference Letter Template 13

Internship Supervisor Feedback Form 14

PSUSD Agreement for Affiliation 15

PSUSD WBL Coordinator Site Supervision Form 19

DHSHS WBL Training Agreement 20

PSUSD Field Trip Notice & Medical Authorization 21

PSUSD Student Internship Program Brochure 23

Contact Information Work Based Learning Coordinator Mr. Michael Phelan (760) 288-7074 [email protected]

CTE Instructor & PSA Co-Coordinator Mr. Eric Huber (760) 288-7000 ext. 4032458 [email protected]

Science Instructor & PSA Co-Coordinator Mrs. Christine Becerra (760) 288-7000 ext. 4032401 [email protected]

Palm Springs Unified School District does not discriminate on the basis of race, color, national origin, sex, or sexual orientation, handicap or (disability), or age in any of its policies, procedures, or practices in compliance with Title VI of the Civil Rights Act and title IX of the Educational Amendments.

COVID-19 Announcement

PSA is following state, district, and site protocols for personal safety. Students will not be participating in events that will compromise their health and safety. During Distance Learning, mentor/internships will be virtual; however, students will need to be ready to adhere to this Internship Handbook if/when restrictions are lifted.


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Internship Program Overview

Program Description: An internship is defined as a hands-on professional learning experience where a student works at an off-campus location to gain work experience. An internship can be an excellent and eye-opening way to decide if a certain career is in fact the right fit. All academy students on-track for graduation are required to participate in an internship their senior year. Students are supported throughout the program by their coordinators and instructors and are graded on hours worked, attendance, assignments, professionalism, and evaluations by their intern supervisor.

• Students are not paid.

• Work Permits are not required.

• Worker’s Compensation Insurance is covered by Palm Springs Unified School District.

• Minimum Required Internship Hours - 24 hours annually.

▪ 12 Hours First Semester & 12 Hours Second Semester

• Students must be placed in an internship directly related to public safety (law enforcement, fire service, emergency medical services), and if possible, in their area of interest.

• This handbook will also be used for students participating in off-campus mentorships.

Student Preparation: Students take a sequence of four career technical education courses in public safety and bring a unique set of skills that can be applied to the workplace. Additionally, as part of the academy experience, students have had exposure to project-based teamwork, community and industry connections, presentations, mentorships, and off-campus experiences (community service and field trips). Internship Placement: Students may be placed into their internship through application, interviews with our public safety business partners, and/or through recommendation by PSA staff. Program Objectives:

1. To provide students with practical experiences that will help make their classroom instruction more meaningful.

2. To provide training opportunities for students to practice skills and attitudes learned in the classroom.

3. To provide an opportunity, with local organizations, for students to acquire skills and knowledge that are best developed on the job.

4. To provide students with the ability to keep up with the changing world of work by putting emphasis on problem-solving, critical-thinking, and decision-making.

5. To provide opportunities for students to make social adjustments and to develop the ability to work cooperatively with co-workers and supervisors.

6. To emphasize to students the importance of being able to follow directions, pay attention to details, and accept supervision.

7. To provide relevant instruction to help students prepare for public safety occupations and related professions.

8. To foster an understanding in students of the benefits and responsibilities of gainful employment.

9. To facilitate the transition between school and employment.

10. To point out to students that constant educational growth is necessary for successful employment and good citizenship.


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Internship Hosting & Dates PSA students are motivated young people who are required to participate in an internship as part of their academy experience. We are looking for organizations who would like to host an internship and make a difference in a young person’s life. Students are available for work during:

• First Semester (August 5th - December 18th, 2020)

• Second Semester (January 11th - June 4th, 2021) Steps to Host an Internship

1. Read PSA’s Internship Handbook.

2. Complete the required internship documents.

3. Attend the Internship Host Orientation.

4. Participate in Intern Interviews.

5. For more information about PSA, please visit www.psadhshs.org. Important Dates & Deadlines

Event Dates

Internship Documents Due August 5th

Internship Host Orientation (Desert Hot Spring High School Campus)

TBD Orientation:

Intern Interview Fair (Desert Hot Spring High School Campus)

TBD Interviews Group A Interviews Group B

Interns’ Start Date (First Day at Work Site)

TBD

Intern Non-Workdays (Dates interns are not required to work due to school holidays) Note: Students are not available Mon. & Thur. afternoons because of the dual enrollment course.

Sept. 07th (Labor Day) Oct. 12th (No School) Nov. 11th (Veterans Day) Nov. 23rd - 27th (Thanksgiving Break) Dec. 19th - Jan 10th (Winter Break) Jan. 18th (MLK Jr. Day) Feb. 12th - 15th (Presidents’ Day) Mar. 27th – Apr. 11th (Spring Break) May 31st (Memorial Day)

Interns’ End Date (Last Day at Work Site)

April - TBA

Interns’ Final Presentations (Hosts, teachers, PSA students/staff, and families invited)

May - TBA

COVID-19 Announcement

During Distance Learning, we will have mentor/internships virtually. All dates and locations will be TBD (To Be Determined) until restrictions are lifted and we (PSA and industry partners) have an updated meeting.


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Intern’s Work Schedule

This document is to be filled out by the student and intern supervisor. Four copies should be made and each of the following persons should keep a copy: student, intern supervisor, WBL Coordinator, and PSA Coordinator/Instructor. Intern’s Start Date: End Date:

Dress Code:

Work Schedule (Please fill in with hours on the appropriate days.)

Sunday Reporting Time: Leave Time:

Monday Reporting Time: Leave Time:

Tuesday Reporting Time: Leave Time:

Wednesday Reporting Time: Leave Time:

Thursday Reporting Time: Leave Time:

Friday Reporting Time: Leave Time:

Saturday Reporting Time: Leave Time:

Please mark the calendar below by circling all days you will be working at your internship.

• Internships must complete by TBA.

2020-2021 Academic Calendar (Subject to change due to COVID-19.)


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Public Services Knowledge & Performance Anchor Standards

(Career Technical Education Model Curriculum Standards, 2013)

This list of standards is to be used to complete the intern’s Learning Goals (located on the WLB Coordinator Site Supervision Form), Intern’s Worksite Evaluation(s), and Internship Mid-Term and Final Presentation.

2.0 Communications

2.3 Interpret verbal & nonverbal communications & respond appropriately.

2.4 Demonstrate elements of written & electronic communication such as accurate spelling, grammar, & format.

2.5 Communicate information & ideas effectively to multiple audiences using a variety of media & formats.

3.0 Career Planning & Management

3.2 Evaluate personal character traits such as trust, respect, & responsibility & understand the impact they can have on career success.

3.4 Research the scope of career opportunities available & the requirements for education, training, certification, & licensure.

3.6 Recognize the role & function of professional organizations, industry associations, & organized labor in a productive society.

3.9 Develop a career plan that reflects career interests, pathways, & postsecondary options.

4.0 Technology

4.1 Use electronic reference materials to gather information & produce products & services.

4.3 Use information & communication technologies to synthesize, summarize, compare, & contrast information from multiple sources.

4.5 Research past, present, & projected technological advances as they impact a particular pathway.

5.0 Problem Solving & Critical Thinking

5.1 Identify & ask significant questions that clarify various points of view to solve problems.

5.2 Solve predictable & unpredictable work-related problems using various types of reasoning (inductive, deductive) as appropriate.

5.3 Use systems thinking to analyze how various components interact with each other to produce outcomes in a complex work environment.

6.0 Health & Safety

6.1 Locate, & adhere to, Material Safety Data Sheet (MSDS) instructions.

6.3 Use health & safety practices for storing, cleaning, & maintaining tools, equipment, & supplies.

6.5 Demonstrate how to prevent & respond to work-related accidents or injuries; this includes demonstrating an understanding of ergonomics.

7.0 Responsibility & Flexibility

7.4 Practice time management & efficiency to fulfill responsibilities.

7.5 Apply high-quality techniques to product or presentation design & development.

7.7 Demonstrate the qualities & behaviors that constitute a positive & professional work demeanor, including appropriate attire for the profession.

8.0 Ethics & Legal Responsibilities

8.3 Demonstrate ethical & legal practices consistent with Public Services sector workplace standards.

8.5 Analyze organizational culture & practices within the workplace environment.

8.7 Conform to rules & regulations regarding sharing of confidential information, as determined by Public Services sector laws & practices.

9.0 Leadership & Teamwork

9.1 Define leadership & identify the responsibilities, competencies, & behaviors of successful leaders.

9.6 Respect individual & cultural differences & recognize the importance of diversity in the workplace.

9.7 Participate in interactive teamwork to solve real Public Services sector issues & problems.

10.0 Technical Knowledge & Skills

10.2 Comply with the rules, regulations, & expectations of all aspects of the Public Services sector.

10.3 Construct projects & products specific to the Public Services sector requirements & expectations.

10.4 Collaborate with industry experts for specific technical knowledge & skills.


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How Interns Will Be Graded For the duration of the Internship Program, students will be graded in three major areas as follows:

1. Collected Assignments

Assignment Due Date

Internship Student Contract

Internship Parent/Guardian Contract

Intern’s Work Schedule

Intern’s Learning Goals (located on the WBL Coordinator Site Supervision Form)

DHSHS WBL Training Agreement

PSUSD Voluntary Field Trip Notice & Medical Authorization

Intern’s Orientation Checklist

Journal Reflections on Internship Experience (quarterly)

Intern’s Worksite Evaluation (x2)

Copy of Thank You Letter to Intern Supervisor

Copy of Thank You Letter to the Host Site

*Copy of Intern Supervisor Letter of Reference (not required, extra credit)

Internship Mid-Term Presentation

Internship Final Presentation

Internship Hours (recorded correctly, on time, and in the correct online form)

2. Attendance Attendance at internships is MANDATORY. You will attend internships every day that you are scheduled to work, even if you are not present at school. If an emergency occurs and you cannot attend or will arrive late, you must contact your intern supervisor at least 2 hours in advance and the WBL and PSA Coordinators. You may be marked down for every absence, regardless of the reason for the absence. Remember that absences and tardies will also affect your intern supervisor’s evaluation of you! 3. Behavior On-Site You are always expected to be respectful and professional at your internship. You will receive a grade on your behavior based on your intern supervisor’s evaluations of you. The following behaviors will NOT be tolerated and will affect your grade and possibly your internship:

• Being Off-Task

• Not Following Directions

• Talking Back

• Complaining

• Using Foul Language

• Dressing Inappropriately

• Talking on Your Cell Phone or Texting

• Messing Around

• Bringing Personal Drama to the Workplace

• Acting Immaturely

Your intern supervisor will be giving you two formal evaluations; however, they have been asked to call WBL/PSA Coordinators to comment on your behavior and attendance at any time. The scores you receive on your two formal evaluations will translate into “bonuses” (extra points in grade) or “docked pay” (loss of points). At the end of your internship, you may also ask your intern supervisor for a formal Reference Letter, but only if you know you have done an outstanding job at your site!


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Internship Mid-Term & Final Presentation

The following are the directions and outline for your mid-term and final presentation. Directions

1. Use a PowerPoint or Google Slides format.

2. Photographs are required in your presentation. Include: your internship site, you performing tasks, and you with your intern supervisor. Please obtain permission from your intern supervisor prior to taking photos.

3. You will visually and orally present your presentation to teachers, business partners, families, and peers. Outline: Host Site

1. Brief Overview & History of Host Site a. What industry does it fall under? b. What is their scope of employment? c. What is their mission and/or purpose?

2. Organization Basic Information

a. How many employees (give details on both sworn and civilian employees)? b. Chain of Command c. What different jobs are there? (give examples) d. What education level is needed at the different jobs? (give examples)

3. Essential Skills

a. Use the Public Services Knowledge & Performance Anchor Standards, list on page 6, to address one sub-standard from each of the 9 standards. (give examples)

b. List 3 standards you believe will be transferable to other jobs or industries in your future? (explain)

4. Strengths & Weaknesses a. What is the best thing about the host site? (explain) b. Identify at least one area in which the host site could improve. (explain)

Outline: My Internship Experience

5. My Job Position a. What was your job description? b. Who did you work with or under on a regular basis? (give their full name, job title, educational

background, and experience) c. What did a typical day of work look like for you? What did you do? (give examples in chronological order,

use a timeline format)

6. Accomplishments & Contributions a. What types of projects or work did you do for the host site? b. How did your contributions fit into the Host Site’s mission and/or purpose statements? c. What were you most proud of? (give examples of actions you took that you felt made a difference)

7. What You Learned

a. Describe 3 concrete things you learned from this experience (specific skills, specific technology, something you learned about yourself, a mistake you learned from, a misconception that was clarified, etc.)

8. Conclusion

a. Your overall feelings about your internship experience/favorite things about it. b. How will this experience affect your future?


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Internship Student Contract I,

, understand that as an intern at

Student Intern’s Legal Name

Host/Job Site

I am required to adhere to the following expectation of appropriate workplace conduct while I am on the internship.

a) I will only work when and where assigned.

b) I will always notify my intern supervisor and WBL/PSA Coordinators if I will be absent or tardy for any reason.

c) I will meet monthly with my intern supervisor and WBL/PSA Coord. to report progress and receive feedback.

d) I will be punctual, conscientious in the fulfillment of my commitment, and perform my duties as assigned.

e) I will conduct myself in a dignified, courteous, and considerate manner.

f) I will accept supervision graciously.

g) I will take any problems, criticisms, or suggestions to my intern supervisor.

h) I will follow all organization policies and procedures (dress code, safety training, etc.)

i) I will always knock on closed doors.

j) I will refrain from loud talking, profanity, inappropriate language or laughing.

k) I will refrain from using my mobile phone (text or calls) while at work

l) I will not chew gum or eat food while working.

m) I will not accept tips or gratuities.

n) I will not use company phones or computers for personal communication, etc.

o) I will not bring family and/or friends to the work site.

p) I will not discuss race, religion, politics, and/or sexually explicit topics with the public or others.

q) Recording of Hours: I will record my hours, after each workday, in the designated online Google Form for credit.

r) Dress Code: This is to assist you in knowing how to dress appropriately for the interviews and at the work site. People will judge you by how you dress, so be prepared to make a great impression.

Yes No

YOU ARE REQUIRED TO WEAR YOUR PSA UNIFORM UNLESS OTHERWISE INDICATED BY PSA COORDINATORS! Non-uniform attire: clean pants (i.e. Dockers or dress pants) or dark colored skirt for girls) Non-uniform attire: clean plain colored shirt with short or long sleeves and plain white t-shirt

No Jeans No Spaghetti Straps No Low-Cut Shirts/Blouses No Sweatshirts No Sweatpants No T-Shirts Only No High Heels

No Flip Flops or Sandals No Hats No Visible Tattoos (You must cover

tattoos up with clothing.) No Piercing Jewelry (Such as nose,

eyelids, chin, lips, etc.)

No Jewelry

s) Thank You Letter: After you have completed your internship, you must send a Thank You Letter to your host and intern supervisor as part of your grade. You must ask your internship supervisor for a business card or write down their name, title, and address so that you can mail the letter. We will provide you with a Thank You Letter format and will mail it for you. The letter must have correct spelling and punctuation and be readable. We will proofread all the letters before it is mailed.

We feel internships are a valuable learning experience for you to explore careers and gain transferable work skills in a professional setting. Remember, you represent the Desert Hot Spring High School, Public Safety Academy, and your host site. By signing below, you agree to and understand the conditions above, have read the PSA Internship Handbook and understand the expectations and consequences. Thank you for agreeing to this contract. Student Signature: Student ID #:

Date:


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Internship Parent/Guardian Contract Your son/daughter has a unique and beneficial opportunity to be off campus for an internship with a public safety organization. This internship experience is a requirement for our PSA grant. All internship placements have been pre-approved by PSUSD, DHSHS, and PSA and all supervisors have undergone a training prior to hosting an intern. The WBL Coordinator and/or PSA Coordinators/Instructors will be in constant communication with the intern supervisor and will also visit all host sites. To leave campus for this privilege, it is important that students and parents/guardians understand our PSUSD, DHSHS, and PSA policies regarding leaving campus. Please read carefully and then sign below agreeing to the terms listed.

• I have read the PSA Standard Operating Procedures, completed the PSA Student Contract and Hold Harmless Agreement, and have read and completed all sections of the PSA Internship Handbook.

• Students must complete all required PSA documents, be in good standing with the academy, and have the required medical insurance. (If your son/daughter is not covered by medical insurance please contact the PSA Coordinators.)

• Students must complete and turn in all required internship documents.

• Students will only attend the internship on days agreed upon by WBL/PSA Coord., intern supervisor, and student.

• Students must report to their internship every schedule workday on time, dressed appropriately per the required dress code, and prepared for the work.

• Students must always conduct themselves professionally.

• Student must be passing all classes and have excellent school attendance to qualify to participate.

• If the student cannot attend the internship for a permissible reason (internship supervisor's request or student on-campus activity), then the student must remain on campus or in class. In such an event, advance notice must be given to the WBL/PSA Coordinator and internship supervisor.

• I fully understand that participants are to abide by all rules and regulations governing conduct during this activity and that I may be called to pick up my child from the activity if s/he demonstrates otherwise. I also understand that is my child is absent from school without a doctor’s excuse on the school day following this activity, s/he may be subject to disciplinary action

• If a student is found to not be at their internship after signing out of school or does not show up, has unreliable attendance, and/or rude behavior, then the following will be enforced by the PSA staff and DHSHS administration:

• Dismissal from the internship program during school hours. Student will lose their internship privilege and will remain in class each day.

• Receive an academic grade of a "F" for the Internship Program.

• Receive consequences from DHSHS administration for truancy and/or inappropriate behavior. This may include Saturday School, loss of senior privileges, removal from PSA, and/or school suspension.

We feel internships are a valuable learning experience for your son/daughter to explore careers and gain transferable work skills in a professional setting. Remember that your son/daughter represents the Desert Hot Spring High School, Public Safety Academy, and their internship site. By signing below, you agree to and understand the conditions above, have read the PSA Internship Handbook and understand the requirements and consequences. Thank you for agreeing to this contract. I give permission for my son/daughter (student’s legal name): _________________________________________________ to participate in the PSA Internship Program. I give permission for my son/daughter’s information (that is listed in this handbook) to be released to the host site and/or intern supervisor for the purpose of career exploration, mentoring, internship opportunity, and their safety in case of an emergency. Parent/Guardian Name (Print): Work Phone #:

Home Address: Cell Phone #:

Parent/Guardian Signature: Date:


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Intern’s Orientation Checklist We recommend intern supervisors use this for first-day orientation with interns. Student Name:

Intern Supervisor Name & Title:

Host & Work Site:

I. Welcome & Introduction

What does it mean to work at this organization? Mission & Purpose Statements, etc.

II. Workplace Tour

Check-In Procedures Overall Tour of Facility Tour of Workspace Exits & Evacuation Routes Introduction to Staff

III. Tour of Employee Facilities

Parking Restrooms Break Rooms Telephones Storage for Personal Belongings

IV. About the Organization

Type of Industry & Services Provided Who is served by the organization? Other Sections or Divisions Discussion of Organization Structure Key People in the Organization

V. Department Specifics

Telephone Number & Address Explanation of Work Schedule Hours/Break Times (If Applicable) Location of Time Clock/Sign-In Attendance Requirements Working with Other Sections/Employees

VI. Job Specific

Job Description & Training Plan Evaluation Procedures How to use phone/office equipment? Location of Necessary Supplies

VII. Safety Training

Emergency/Disaster Protocols Injury Protocols Accident Prevention Fire Extinguishers Special Hazards

VIII. Supervisor's Expectations

Performance Expectations Dress Code (Hair, Clothing, Jewelry, etc.)

Organization Culture (Teamwork, Values, etc.) IX. Materials/Technology

Personnel Handbook Organization Chart Telephone or Email Contacts Security/Login Procedures Computer or Laptop (If Needed)

Notes:

Orientation Completed:

Student Signature: Date:

Intern Supervisor Signature: Date:


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Intern’s Worksite Evaluation

Directions: Please complete one student/intern evaluation each semester (due in December and May). Thank you. Student Name:


Host & Work Site:

Exceeds Expectations

Meets Expectations

Needs Improvement

Does Not Appy

1. Works both independently and collaboratively. ❑ ❑ ❑ ❑

2. Attends internship on a regular basis and telephones prior to absence due to illness or emergency.

❑ ❑ ❑ ❑

3. Comes to work on time. ❑ ❑ ❑ ❑

4. Dressed and groomed appropriately for the job. ❑ ❑ ❑ ❑

5. Communicates with employees, public, etc. ❑ ❑ ❑ ❑

6. Performs reliably and responsibly. ❑ ❑ ❑ ❑

7. Serves the public and works well with diverse populations. ❑ ❑ ❑ ❑

8. Performs the essential tasks related to this occupation. ❑ ❑ ❑ ❑

9. Demonstrates the proper use of industry terminology. ❑ ❑ ❑ ❑

10. Practices good safety procedures. ❑ ❑ ❑ ❑

11. Solves problems, thinks critically, and makes good decisions. ❑ ❑ ❑ ❑

12. Plans work and takes initiative. ❑ ❑ ❑ ❑

13. Demonstrates ability to manage resources well. ❑ ❑ ❑ ❑

14. Demonstrates leadership and willingness to help and train others.

❑ ❑ ❑ ❑

15. Demonstrates health & safety practices. ❑ ❑ ❑ ❑

16. Works well as a team member within the organization. ❑ ❑ ❑ ❑

17. Selects appropriate equipment, applies technology to specific tasks, and/or maintains/troubleshoots equipment.

❑ ❑ ❑ ❑

18. Demonstrates poise and confidence. ❑ ❑ ❑ ❑

19. Demonstrates a positive attitude. ❑ ❑ ❑ ❑

20. Produces quality work consistent with assigned objectives. ❑ ❑ ❑ ❑

Comments:

Student Signature: Date:

Intern Supervisor Signature: Date:


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Reference Letter Template At the end of the internship, students/interns who feel they have performed admirably are asked to request a Reference Letter from their intern supervisor. Please refer to the Reference Letter template below. If a Reference Letter is not deserved, then the intern supervisor is encouraged to write a Letter of Completion. We appreciate your time and consideration with writing this letter. [Please type Reference Letter or Letter of Completion on your official letterhead.] Date Dear Sir or Madam, The first paragraph should explain the connection to the student you are referencing. Include: how you know them, why you are qualified to write a reference letter to comment on their character, and a description of the internship relationship you had with them. Example: I have had the great pleasure of employing [student name] as a student intern here at [name of worksite] for the [time period]. As a volunteer community Intern Supervisor in Desert Hot Spring High School’s Public Safety Academy Internship Program, I have regularly observed [student] as they have learned the duties of [intern’s job description]... The second paragraph should contain information on the student’s transferable skills (qualities that employer value and/or refer to page 6, Public Services Knowledge & Performance Anchor Standards) that you have observed in your student during the course of the internship. Here you could discuss two or three skills/standards that you have noticed your student excel in. In discussing those skills/standards, support statements with examples of how he or she demonstrated those attributes either in your presence or in activities/projects where you saw positive results. Please be as concrete and detailed as possible. Example: [Student] is not only an excellent communicator, but also possesses a remarkable ability to navigate through complicated situations or databases… The third paragraph should contain information on the character of the student you are writing about. Choose two or three specific qualities that you observed in your student. In discussing those qualities, support statements with examples of how he or she demonstrated those attributes either in your presence or in activities you know they have been involved. Be as concrete and detailed as possible. Example: During the course of his/her internship, I have found [student] to be energetic, honest, and future-driven… The concluding paragraph should contain an offer to provide more information. Include a phone number within the paragraph, and end with a positive remark about student’s prospects. Sincerely,

Intern Supervisor’s Signature Intern Supervisor’s Name (Typed) Intern Supervisor’s Title Intern Supervisor’s Contact Information


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Internship Supervisor Feedback Form The PSUSD, DHSHS, and PSA appreciate and thank you for your participation in our Internship Program. You have provided an extraordinary learning experience for our students. Please take a moment to give us your feedback.


Host & Work Site:

Name of Student Intern(s):

1. What skills or situations required on the job did you find your intern(s) was prepared for?

2. What skills or situations required on the job did you find your intern(s) was unprepared for?

3. Was participating in the PSA Internship Program an overall positive experience for you? Why or why not?

4. Please comment on the quality of communication you had with:

a. Work Based Learning Coordinator

b. PSA Coordinators/Instructors

5. Please comment on anything else you feel would improve the Internship Program.

6. May we continue our Internship Program partnership next year? ◻ Yes ◻ No

Affiliate Number WBL-_______________________

Modified 09/12/18 Page 1

PALM SPRINGS UNIFIED SCHOOL DISTRICT

150 District Center Drive

Palm Springs, CA 92264

Palm Springs Unified School District Work-Based Learning Program

Agreement for Affiliation

This Agreement (“Agreement”) is made and entered into as of the later of ______________________, or the execution of the

Agreement by both parties (the “Effective Date”) between Palm Springs Unified School District (“DISTRICT”), and

_____________________________________________________________________ (“AFFILIATE”).

WHEREAS, the DISTRICT operates a Career Technical Education (CTE) Work–Based Learning Program (“Program”) for

its students under which students receive academic credit towards their high school diploma for participation in a work place setting

learning about the different types of vocational or occupational training offered through the Program, and,

WHEREAS, the AFFILIATE has the below listed facility(ies) and is willing to make it/them available to the DISTRICT’s

students accepted into the Work Based Learning (WBL) Program (herein referred to as “Accepted Students”), at no cost, for the use in

the work-based mentoring of the DISTRICT’s students enrolled in the Program, and/or is willing to provide work-based mentoring to

students enrolled in the Program at their school sites.

Address(es): __________________________________

__________________________________

__________________________________

NOW, THEREFORE, in consideration of the terms and conditions set forth herein and for other good and valuable

consideration, the receipt and sufficiency of which are hereby acknowledged, the DISTRICT and AFFILIATE agree as follows:

1. Term and Termination. The term of this Agreement shall be five (5) years commencing on the later of _________________,

or the execution of the Agreement by both parties (the “Effective Date”). This Agreement may be renewed through mutual

written agreement signed by both parties. This Agreement may be terminated by either party with or without cause upon thirty

(30) days’ written notice to the other party.

2. Use of Facility(ies). The AFFILIATE agrees to make the above-listed facility(ies) available to the DISTRICT for the

instruction of the Accepted Students enrolled in a WBL Program.

a. The Accepted Students will be subject to the rules and regulations of the AFFILIATE during the hours they are within

the AFFILIATE’S facility(ies) and participating in the WBL Program at the facility(ies). DISTRICT shall

communicate and advise Accepted Students on their responsibility for complying with AFFILIATE rules, regulations,

policies and procedures and ensure students’ compliance with the same.

b. Students will wear appropriate identification to designate them as Accepted Students.

3. Program Operations.

a. All instruction, time schedules, and use of AFFILIATE’s facility areas or departments will be coordinated by

DISTRICT staff and the managing personnel of the AFFILIATE.

b. The AFFILIATE will provide necessary orientation to the Accepted Students.

c. Accepted Students in an unpaid internship will not displace regular employees of the AFFILIATE.



d. Accepted Students in an unpaid internship shall not be entitled either to pay or benefits for the instructional or training

time, or services rendered at the AFFILIATE’s facility(ies), or to a job with the AFFILIATE at the conclusion of the

training/Program.

e. The AFFILIATE will provide a safe and clean work environment that complies with all Occupational Safety and

Health Administration (OSHA) standards and codes as set forth by the U.S. Department of Labor, and the derivative

Cal/OSHA standards, laws, and regulations relating thereto.

f. The DISTRICT shall bear all expenses of conducting the Program class. The AFFILIATE shall have no obligation

under this Agreement, except as herein provided.

g. The DISTRICT shall abide by all provisions of the California Administrative Code, Title V, and the Community

Classroom and Cooperative Vocational Education requirements and all other applicable laws, rules and regulations,

local, state, and federal.

h. Employees or agents of AFFILIATE who enter onto DISTRICT premises for purposes of providing mentoring or

training to students shall be subject to any health or safety requirements established by the DISTRICT. Prior to

commencing work under this Agreement that would require working with students on DISTRICT premises while not

under the supervision of a district employee, AFFILIATE’s affected employees and agents shall (according to

DISTRICT policies and procedures) be fingerprinted and shall provide proof of all required health clearances,

including, but not limited to tuberculosis clearance.

i. Nothing herein shall be interpreted to require AFFILIATE to accept students from the Program for mentoring at the

listed facilities. This decision to accept any students shall be made by AFFILIATE, in its sole and absolute discretion.

4. Employer and Workers’ Compensation Coverage. The DISTRICT under whose supervision unpaid work experience

education, cooperative vocational education, community classrooms, or a job shadowing experience, are provided shall be

considered the employer under Division 4 (commencing with Section 3200) of the Labor Code of students receiving this

training. The DISTRICT shall provide Workers’ Compensation insurance coverage for each unpaid Accepted Student who

receives training at AFFILIATE’s facility(ies).

5. Screening Requirements. DISTRICT understands and agrees that Accepted Students will be required to meet certain

screening, immunization, background checks and other competency standards that AFFILIATE may require, in its sole

discretion. These requirements are subject to change and may vary depending on the nature of the training program. A list of

AFFILIATE requirements for students shall be made available upon request. Accepted Students must meet all requirements of

AFFILIATE prior to participating in the Program at the facility.

6. Withdrawal of Students. AFFILIATE may immediately remove from the premises any student who poses an immediate

threat or danger to personnel or to the quality of services or for unprofessional behavior, and for any other lawful purpose.

AFFILIATE may request DISTRICT to withdraw or dismiss a student from the Program at the facility when his or her

performance is unsatisfactory to AFFILIATE or his or her behavior, in AFFILIATE’s discretion, is disruptive or detrimental

to the AFFILIATE and/or its customers, employees, or visitors. In such event, said student’s participation in the Program at

the facility shall immediately cease.

7. Independent Contractor. The parties hereby acknowledge that they are independent contractors, and neither the District nor

any of its agents, representatives, students or employees or Program Participants shall be considered agents, representatives, or

employees of the AFFILIATE. The AFFILIATE is an independent contractor, and is not an officer, agent, or employee of the

DISTRICT, and has no authority to contract or enter into any other agreement in the name of the DISTRICT. In no event shall

this Agreement be construed as establishing a partnership or joint venture or similar relationship between the parties hereto, or

between or among the AFFILIATE and any and all students. The provisions set forth herein shall survive expiration or other

termination of this Agreement regardless of the cause of such termination.

8. Insurance. The AFFILIATE agrees to maintain, at all times during the term of this Agreement and for a period of three (3)

years thereafter, a comprehensive program of risk retention and insurance with such insurance carriers and in such amounts of

insurance coverage reasonably acceptable to the DISTRICT, and to provide the DISTRICT with copies of certificates of

insurance and/or other evidence of insurance coverage upon request. The DISTRICT shall secure and maintain during the term

of this Agreement, comprehensive general public liability insurance for each Accepted Student and DISTRICT instructor of at

least One Million Dollars ($1,000,000) for each claim, up to a total of Three Million Dollars ($3,000,000) in any one year, to

cover claims and liabilities for personal injury, death or property damage arising from the activities of the DISTRICT.

Incidental malpractice is included in the provisions of the comprehensive general liability insurance so long as the student and



instructor are acting within the scope of their assigned duties. DISTRICT shall provide AFFILIATE with copies of certificates

of insurance and/or other evidence of insurance coverage upon request.

9. Indemnification and Hold Harmless. Both parties shall defend, indemnify and hold harmless the other party, its officers,

employees, agents and students from and against any and all liability, loss, expense (including reasonable attorneys’ fees), or

claims from injury or damages occurring in connection with or incident to or arising out of the occupancy, use, service,

operations or performance of work under this Agreement, to the extent resulting in whole or in part from the negligent, reckless

or intentional acts or omissions of the indemnifying party or its subcontractors, or any officers, employees, agents, or

representatives of the indemnifying party or its subcontractors.

10. Assignment of Contract. Neither the DISTRICT nor the AFFILIATE shall assign the whole or any part of this Agreement,

without the express written consent of the other party and all sureties who have executed bonds on behalf of either party in

connection with this Agreement.

11. Equal Opportunity Clause. The DISTRICT and AFFILIATE and their respective officers, employees, managers, and agents

shall not discriminate against any person on the basis of any protected characteristic, including but not limited to race, religion,

color, national origin, disabilities, marital status, age, or sex. The DISTRICT and AFFILIATE each affirm that it is an equal

opportunity employer and shall comply with any other laws or regulations prohibiting discrimination as may be applicable to

them.

12. Notices. Any notice or communication required or permitted to be given hereunder shall be in writing and served personally,

delivered by courier or sent by United States certified mail, postage prepaid with return receipt requested, addressed to the

other Party as follows:

To DISTRICT:

Palm Springs Unified School District

Attention: Brian Murray, Ed.D.

Title: Asst. Superintendent Business Services

150 District Center Drive

Palm Springs, CA 92264

To AFFILIATE:

Affiliate:

Attention:

Title:

Address

and/or to such other persons or places as either of the Parties may hereafter designate in writing. All such notices shall be

effective when received.

13. Governing Law. This Agreement is made and entered into in the State of California, and shall in all respects be interpreted,

enforced, and governed under the laws of said State without giving effect to conflicts of laws principles.

14. Severability. Should any portion, word, clause, phrase, sentence, or paragraph of this Agreement be declared void or

unenforceable, such portion shall be considered independent and severable from the remainder, the validity of which shall

remain unaffected.

15. Entire Agreement; Amendments to Agreement. This Agreement constitutes the entire agreement between the Parties who

have executed it and supersedes any and all other agreements, understandings, negotiations, or discussions, either oral or in

writing, express or implied between the Parties to this Agreement. All provisions of this Agreement hereto shall remain in

effect throughout the term thereof unless the Parties agree, in a written document signed by both Parties, to amend, add or

delete any provision, except that the DISTRICT may amend the Agreement to accomplish changes required by law. Email

correspondence shall not qualify as a written document signed by an authorized signatory.

16. Headings. The headings contained in this Agreement are for convenience only and shall not in any way affect the meaning or

interpretation hereof nor serve as evidence of the interpretation hereof, or of the intention of the parties hereto.

17. Waiver. No waiver shall be binding, unless executed in writing by the party making the waiver and agreed to by both parties.

No waiver of any provision of this Agreement shall be deemed, or shall constitute, a waiver of any other provision, whether or

not similar, nor shall any such waiver constitute a continuing or subsequent waiver of the same provision. Failure of either

party to enforce any provision of this Agreement shall not constitute a waiver of the right to compel enforcement of the

remaining provisions of this Agreement.



IN WITNESS WHEREOF, the parties hereto have executed this agreement on the day and year first above written.

Palm Springs Unified School District Affiliate:

Address:

Authorized Signature Authorized Signature

Printed Name and Title Printed Name and Title

Date: Date:

(Check one that applies)

o Agriculture and Natural Science

o Arts, Media, and Entertainment

o Building Trades and Construction

o Education, Child Development, and Family

Services

o Energy and Utilities

o Engineering and Design

o Fashion and Interior Design

o Finance and Business

o Special Education

o Health Science and Medical Technology

o Hospitality, Tourism, and Recreation

o Information Technology

o Manufacturing and Product Development

o Marketing, Sales, and Service

o Public Services

o Transportation

Palm Springs Unified School District

WBL Coordinator Site Supervision Form

Placement Type (circle one): Paid Internship Unpaid Internship Work Experience Job Shadow

Student Information

Student Name: Grade:

12th Date of Birth (Age):

( )

Address:

City: H Phone:

School:

Desert Hot Springs High School

Public Safety Academy

Address:

65850 Pierson Boulevard

Desert Hot Springs, CA 92240

C Phone:

Email:

Employer/Internship Host Information

Business Name:

Supervisor Name/Title:

Business Address:

Phone:

Website:

Email:

Internship Goals

Career Focus Area (type of occupation):

Learning Goals (you may add as many as are appropriate):

1.

2.

3.

Student Signature:

Site Supervisor Signature:

Record of Supervision Visits

Date Time Code Observation/Progress/Supervisor Comments

Codes: E = Deliver/Collect Evaluation C = WBL/Teacher/Employer Conference S = Student Observation

TRAINING AGREEMENT

Internship Program - Desert Hot Springs High School

The purpose of the Internship Program is to assist students in defining their interests and determining their suitability to various

occupations. The program offers students the opportunity to observer a variety of occupations at a business/organization; this is unpaid

employment. This Agreement is to specify the roles and responsibilities of the participants – student, parent/guardian, host organization,

and school involved, so that the student can achieve high school credits for participating in this Internship Program.

➢ The Student will:

1. Be enrolled in the Public Safety Academy and in good standing.

2. Maintain acceptable levels of school attendance and academic performance.

3. Attend school as per DHSHS and PSA policy and attend WBL-Internship classes.

4. Be on time to class, just like at the host organization.

5. Students must inform their host intern supervisor and the WBL and PSA Coordinators in advance of any absence or

lateness.

6. Cooperate with the host personnel.

7. Be prepared to produce weekly or quarterly assignments (as assigned) reflecting on learning experiences.

➢ The Parent/Guardian will:

1. Give permission for their son/daughter (student) to leave school to go to the host organization site.

2. Assume liability for the safety and conduct of the student while traveling to and from the school, intern site, and home.

3. Approve of the student’s enrollment in this Internship Program.

➢ The Host Organization & Intern Supervisor will:

1. Provide adequate adult supervision, so that the student will be safe and receive adequate educational training.

2. Assist the student with developing an Individual Intern Training Plan each semester.

3. Ensure that the nature of the work is project-oriented and observatory in nature, according to Fair Labor Standards Act

(more information available upon request) and that the student does not replace or displace employees.

4. Schedule regular times to meet with interns to give him/her feedback.

5. Notify the WBL Coordinator and PSA Coordinator(s)/Instructor anytime the student is absent or late and/or if there are

deficiencies in learning and/or behavior.

6. Complete evaluations of the intern’s performance each semester and provide a letter of reference upon completion.

7. Not discriminate on the basis of race, color, national origin, sex, or sexual orientation, handicap (or disability), or age in

any of its policies, procedures, or practices in compliance with Title VI of the Civil Rights Act and Title IX of the

Educational Amendments.

➢ The School will:

1. Approve the student’s host and work site.

2. Ensure that Training Agreement and Training Plan are completed and in the student’s file, and maintain all records as

required by the California Department of Education and California Code of Regulations, Title 5, for issuing course credits.

3. Conduct a minimum of two site visits per semester with an intern supervisor at the student’s intern site.

4. Provide the related instruction and supervision during the semester to ensure the student’s success.

5. Not discriminate on the basis of race, color, national origin, sex or sexual orientation, handicap (or disability), or age in any

of its policies, procedures, or practices in compliance with Title VI of the Civil Rights Act and Title IX of the Educational

Amendments.

I AGREE TO THE PROVISIONS ABOVE

➢

Intern Supervisor Signature Host Organization Date

➢

Student Signature Date For Information Contact:

➢

Parent/Guardian Signature Date

➢

PSA Instructor Signature Date

Exhibit BP6153 (C)

Student’s ID# Student’s Last Name Student’s First Name

Palm Springs Unified School District Voluntary Field Trip Notice And Medical Authorization

Dear Parent/Guardian, This form is PSUSD’s legal document for when students leave campus for any reason. Even though this document indicates that it is a “Voluntary Field Trip Notice or Voluntary Activity,” the DHSHS Public Safety Academy must use this document for our grant REQUIRED/MANDATORY off-campus Mentorship and Internship Program for the school year. Please complete and return to .

My son/daughter, , has my permission to participate in the

following voluntary activity. Destination:

Departure Date & Time: Return Date & Time:

Transportation: School Bus School/District Vehicle In the event of illness or injury, I give my consent to whatever x-ray, examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care are considered necessary in the best judgment of the attending physician, surgeon, or dentist and performed by or under the supervision of a member of the medical staff of the hospital or facility furnishing medical or dental services. As stated in California Education Code Section 35330, I understand that I hold the Palm Springs Unified School District its officers, agents, and employees harmless from any and all liability or claims, which may arise out of or in connection with my child’s participation in this activity. I fully understand that participants are to abide by all rules and regulations governing conduct during the trip. Any violation of these rules and regulations may result in that individual being sent home at the expense of his/her parent/guardian. Parent/Guardian Signature: Date:

Address: Phone:

Student Signature: Date of Birth:

Medical Insurance Carrier: Policy Number:

Address:

1) If your son/daughter has a special medical problem, kindly attach a description of that problem to this sheet.

2) _____ Check here if any medication(s) is required on this trip.

3) Medication(s) must be registered on this form and must have prior physician authorization (obtained at school); please list here name of medication(s) and reason __________________________________________________________

_____________________________________________________________________________________________

4) All medications must be kept and distributed by staff, except those, which must be kept on the student’s person for emergency use and with prior authorization only.