Page 1 of 14 Copyright (c) 2016 by Denver Public Schools, Revised 10-20-17

DPS CareerLaunch Work Study Information Sheet Work Study Document Checklist:

� * DPS Work Study Information Sheet (page 1)� DPS Work Study Agreement Form (pages 2-5)� Unpaid Work Experience Contract (students with IEPs only) (page 6)� * Credit Declaration (page 7)� DPS Media Release Form (page 8)� Parent Consent for Treatment Form (page 9) and list of clinics (page 10)� Young American’s Bank Student Account Form (page 11) and Custodial Agreement (page 12)� Transportation Permission Form (page 14)

All documents listed above must be completed and on file for students to be issued Work Study credit. Those with an * are required for October Count.

Term: Fall 20_____ Spring 20_____ Summer 20___

__________________________________________________________ ____________________________ (Student Name) (School)

__________________________________________________________ ____________________________ (Name of Internship Company or Organization) (Supervisor’s Name)

_____________________________________________________________________________________________ (Company or Organization Address)

_________________________________________ _________________________________________ (Company or Organization Phone Number) (Supervisor’s Phone Number)

Position is: � Full Time � Part time � Paid DPS Internship � Paid Internship (through other program such as WIA) � Unpaid DPS Internship

______________________________________ Start Date: _________________End Date (if applicable)_________ (Job Title)

Rate of Pay: � Unpaid � Hourly Wage: $______________ � Other:

Work Schedule (Hours/Days of the week)__________________________________________________________

Brief Description of Intern Duties: _____________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

Dress Code: _____________________________________________________________________________________________

DPS Staff Contact Person:

__________________________________________ ___________________________________________ (Name) (Title)

__________________________________________ ___________________________________________ (Cell Phone) (Email)

Page 2 of 14 Copyright (c) 2016 by Denver Public Schools, Revised 10-20-17

DPS WORK STUDY AGREEMENT FORM

THIS AGREEMENT is between ___________________ (student’s name from here named “Student”), the student’s parent or guardian, Denver Public Schools’ (DPS) ___________________ (name of work study program) Program and _______________ (partner company). Program eligibility is contingent on successfully completing the Internship Program enrollment process. School credit for hours worked is awarded to students contingent on completion of district paperwork, submission of documentation of work hours using approved timesheet or pay stub and any additional assignments required by school staff.

All parties agree to the following:

1. Commitmenta. The Student agrees to the following:

i. To be placed as an intern or maintain employment at _________________________(partner company).

ii. To attend required class, workshops, seminars or other work readiness training beforeand/or during the internship/work experience.

iii. To attend all scheduled classes in accordance with school policies or risk losinginternship or forfeit school credit for internship/work.

iv. To work according to the schedule listed on the DPS Internship Information Sheet.v. To provide own transportation to and from work site unless provided by program. If

Student drives, student will ensure the vehicle is insured.vi. To act as an ambassador for Denver Public Schools, its students, faculty, and staff by

conducting oneself in a positive, ethical and respectful manner and maintain goodgrooming, appropriate dress and professional behavior throughoutinternship/employment.

vii. To be familiar with and follow the work site’s employment policies, procedures, dresscode, privacy or confidentiality agreements, and behavioral expectations.

viii. To notify work site and school contact person of absences and/or tardiness according towork site policies and procedures and to inform school contact person of any changes ininternship/work status (cutback of hours, change in work schedule, or dismissal).

ix. To maintain communication with school contact person via email, phone or face to facecontact at school as required by internship/work experience program.

x. To meet the requirements for a passing grade as outlined in course syllabus or programpolicies and to turn in documentation required for school credit to designated schoolstaff person. This may include timesheets, pay stubs, performance evaluations,internship projects, etc. CareerLaunch students agree to turn in a signed, completedtimesheet prior to being issued the final financial award for which he/she is eligible.

xi. If eligible for DPS worker’s compensation coverage, (see item 2, pg 4) to report anyinjuries that occur while performing internship duties and follow DPS worker’scompensation procedures: a) Report injury to internship supervisor and schoolInternship Coordinator, b) Call DPS worker’s compensation hotline and speak directlywith a nurse to provide information related to the incident including details regardingthe occurrence of the incident, immediate physical and/or other symptoms andprior/currently relevant medical history, c) Show up for scheduled appointments andfollow treatment protocol.

b. The parent or guardian agrees:i. To allow student to participate in the DPS CareerLaunch Internship Program.

ii. To support student to meet the requirements of the CareerLaunch Program.iii. To allow the student to engage in a variety of activities that require the sharing of

the student’s personally identifiable information (PII) with CareerLaunch business

Page 3 of 14 Copyright (c) 2016 by Denver Public Schools, Revised 10-20-17

partners. Circumstances where the student’s data may be shared may include but are not limited to the sharing of resume, PII and social media profiles with CareerLaunch business partners as required for intern selection process and onboarding (ex. PII may be necessary for drug testing, criminal background checks, etc. required by business partners).

iv. To encourage Student to communicate directly with worksite supervisor and schoolcontact person when late or absent from work.

v. To provide the support needed for the Student to fully engage in the internshipprogram/work experience.

vi. To assist student with transportation, as needed.vii. For ACE-WES and CareerLaunch students only: To allow school personnel to transport

student in private or district-owned vehicle and/or accompany student when usingpublic transportation when traveling to job/internship interviews and job relatedactivities.

viii. If eligible for DPS worker’s compensation coverage (see item 2, pg. 4), to supportstudent in reporting any injuries that occur while performing internship duties andfollowing DPS worker’s compensation procedures: a) Report injury to internshipsupervisor and school Internship Coordinator, b) Call DPS worker’s compensationhotline and speak directly with a nurse to provide information related to the incidentincluding details regarding the occurrence of the incident, immediate physical and/orother symptoms and prior/currently relevant medical history, c) Show up for scheduledappointments and follow treatment protocol.

ix. For CareerLaunch only: To assist the student with meeting the following programrequirement: Interns must turn in a signed, completed timesheet prior to being issuedthe final financial award for which he/she is eligible.

c. DPS agrees as follows:i. To develop a training plan outlining the specific skills student will learn on-the-job in

collaboration with the Worksite Supervisor/Employer. (See Appendix A for sampleTraining Plan.)

ii. To provide case management support and act as a liaison between the student,parent/guardian, school and work site supervisor.

iii. To ensure that work site conditions meet the requirements of the law and will notendanger the health, safety, or welfare of the student. DPS staff reserves the right towithdraw student from internship/work site when serious concerns arise related tostudent safety and/or well-being.

iv. To visit work site to evaluate student progress and assist supervisor, as needed, to helpthe student meet work site expectations and perform at their full potential.

v. To provide consultative support to Worksite Supervisor to ensure a successful andmeaningful internship experience for the Student and Supervisor.

vi. To issue school credit based on hours worked as documented on timesheet, pay stub, orother district-approved documentation per course syllabus or program policy.

d. The Worksite agrees to the following:i. To permit _______________________ (student name) from ________________

(school) to enter the workplace as an intern under the supervision of___________________ (worksite supervisor’s name) for the purpose of gainingknowledge and experience in the area of _______________________ (careerarea/industry).

ii. Supervisor agrees to obtain parent permission before administering a polygraph, drugtest, physical or other screening prior to internship placement or employment.

Page 4 of 14 Copyright (c) 2016 by Denver Public Schools, Revised 10-20-17

iii. The work site agrees to conform to all federal, state, and local laws and regulations,including Child Labor Laws and non-discrimination on the basis of sex, race, creed, color,disability, or marital status.

iv. Worksite Supervisor(s) and any staff who will have consistent, unsupervised contactwith interns will complete a criminal background check through DPS Safety and Securitybefore internship begins. Supervisor is required to maintain line of sight supervision ofstudent. (Note: This does not apply to students who are on the company’s payroll.)

v. Employer/supervisor will instruct student in office procedures, appropriate dress, officeculture/etiquette, and safety policies and procedures. Denver Public Schools reservesthe right to prohibit internship activities considered high risk or hazardous inaccordance with DPS’ worker’s compensation policy.

vi. Ensure the Student is given the opportunity to gain well rounded experience in a safeenvironment and progress in his/her position as proficiency allows.

vii. To contact school staff if concerns arise regarding Student’s work performance.viii. To maintain confidential information and not reveal it to clients, colleagues, or others

without procuring the necessary releases or authorizations.ix. To verify intern timesheet/work hours and complete the required weekly, midterm

and/or final Performance Evaluations each term, providing feedback on Student’s workquality and ability to meet workplace expectations.

x. To restrict internship hours to 7 AM- 7 PM. Variances need to be approved by DPSCareerConnect staff. (Note: This does not apply to students on the company payroll.)

2. Wages and Worker’s Compensationa. Internships may be unpaid or paid either by DPS, a third party agency or the worksite. Unpaid

internships must meet specific criteria when placing students with disabilities (see Appendix B:Unpaid Work Experience Contract). DPS paid interns are paid an hourly wage. DPS unpaid internsmay be eligible for a financial award based on performance.

b. When a Student is paid by an outside employer or agency, the Participant is covered by theemployer’s worker’s compensation insurance. The Student is otherwise covered by DPS’worker’s compensation policy when engaged in internship related activities. Students covered byDPS worker’s compensation policy must report an injury to his/her supervisor and school contactperson as soon as possible, but no later than 4 business days or may not be eligible for worker’scompensation coverage.

3. Terminationa. Grounds for termination during the internship may include but are not limited to:

i. Academic concerns (drop in grades, attendance, not completing class assignments, etc.)ii. Poor work performance

iii. Unprofessional or inappropriate behavioriv. Failure to meet program expectations

b. In the event that the Student is terminated from the internship program for reasons ofunprofessional or inappropriate behavior while enrolled at _________________ (school name),the Student may face additional disciplinary action as deemed reasonable by the School’s CTEDirector of Pathways and/or other school administrator.

c. Termination may result in a failing grade and/or reduction in number of credits issued.

4. Resignationa. Due to the nature of an internship arrangement, a Student may not withdraw from an internship

without prior authorization from DPS staff except in severe and justifiable circumstances.

Page 5 of 14 Copyright (c) 2016 by Denver Public Schools, Revised 10-20-17

b. If the Student resigns from the internship program before all program requirements arecomplete, the number of credits issued will be determined by the policy stated in the coursesyllabus or program handbook.

5. Confidentialitya. The Student acknowledges that in the course of the internship experience s/he may have access

to and be involved in the processing of verbal, written, filmed, and/or recorded informationrelating to clients, employees or company business.

b. The Student understands he or she is required to maintain confidentiality of this direct orindirect information at all times, both during and after the internship experience. The Studentunderstands that he or she may not share, discuss, or reveal any of this information withanyone.

c. Failing to maintain confidentiality may result in disciplinary action, including termination fromthe internship or legal action.

d. The Student agrees to abide by the confidentiality policy as stated above.

Term: Fall 20_____ Spring 20_____ Summer 20____

This student is expected to complete ________ (please fill in blank) work hours this term.

Student's Name: __________________________ Student Signature: ________________ Date: _________

Intern Supervisor’s Name: _________________ Intern Supervisor’s Signature: _______________ Date: _____

DPS Contact Person’s Name: ________________ DPS Contact Person’s Signature ____________ Date: ______

Parent's Name: ___________________________ Parent’s Signature: ____________________ Date: _______

Page 6 of 14 Copyright (c) 2016 by Denver Public Schools, Revised 10-20-17

APPENDIX B: UNPAID WORK EXPERIENCE CONTRACT (ONLY for Students with IEPs) The student agrees to attend and participate in an unpaid work experience. The business sponsor reserves the right to discontinue the training placement at any time. However, if a problem arises, the business sponsor agrees to discuss the situation with the Teacher/Job Coach in order to identify solutions prior to discontinuing the training experience.

All parties agree to abide by the guidelines developed by the U.S. and State Department of Labor (such as Child Labor Laws and non-discrimination policies) and the U.S. Department of Education for non-paid vocational training sites, to include the following:

If “NO” has been checked on any of the above, this constitutes an employer-employee relationship and does not qualify as an unpaid work experience. If during the unpaid work experience, the conditions change and an employer-employee relationship is established, wages must be paid or the student should be removed from the site. Student is covered by worker’s compensation through DPS. � Yes � No (applies to in-school jobs only)

Please print. Student Name: ______________________________ Work Site Supervisor’s Name: __________________________

Name of Business: _______________________________________________ Type of Business: ________________

Phone Number: _____________ Address: ___________________________________________________________

Primary Job Tasks: _______________________________ Transportation: RTD ___ Walk ___ Private Vehicle ____

Days of Week: _______________ Hours: ____________ Training Start Date: _____________ End Date: _________

School Contact Person: _________________________ Phone Number: ______________________

______________________________/________ ______________________________/___________ Business Sponsor Date Student Date ____________________________/___________ ______________________________/____________ Parent or Guardian Date Teacher/Specialist/Job Coach Date

YES NO DESCRIPTION The student has been identified under IDEA as having a disability. Competitive employment is not immediately available to the student due to the severity of his/her disabilities. The work experience is for vocational exploration, assessment or training. Unpaid Work Experience is documented and clearly identified on the student’s IEP, vocational rehabilitation assessment, and/or IPE. Documentation must include: The need and benefit to the student A clear relationship to the student's transition employment outcome and annual goal(s) The student does not displace or reduce the hours of an existing employee. The student will be under direct supervision by a school representative, a vocational rehabilitation service provider, or an employee of the business. The student needs intensive ongoing support to perform in the work setting. The activities of the student do not result in immediate advantage to the business, or the advantages are clearly offset by the burden of training and supervision. The total hours of the experience will not exceed: 5 hours for vocational exploration per job experience; (career awareness, job shadowing, job site evaluation) 90 hours for vocational assessment per job experience; (situational assessments) 120 hours for vocational training per job experience; (work adjustment training and/or job skills training). The individual is working for training purposes and does not expect, or is not entitled to, a position after completion of the experience. Parent(s) and students are informed and have agreed to participation and understand that no wages will be available for this educational experience. The training position is a clearly distinguishable occupation or job classification (the skills on this training experience can be transferred to paid employment).

Page 7 of 14 Copyright (c) 2016 by Denver Public Schools, Revised 10-20-17

*CREDIT DECLARATION* Required during the school year only for October Count.

Term: Fall 20_____ Spring 20_____

This student is expected to complete ________ (please fill in blank) work hours this term. (This total must match the number of hours stated on the Work Study Agreement).

Student Information:

____________________________________________________ _________________ (Student Name) (DPS Student ID#)

____________________________________________________ (School Name)

Students may earn up to 1 unit per semester. No more than 2 total Work Study units can be applied toward DPS graduation requirements. Students must enroll in a Work Study course prior to beginning work that will count toward Work Study credit.

Specific requirements outlined in the course syllabus must be met in order for a student to earn Work Study credits. These may include academic assignments associated with Work Study, submission of pay stubs or timecards and observation of the student at work by district staff. The number of Work Study credits earned is dependent on the number of hours worked.

Students with IEPs who are working towards a Work Experience Study (WES) Course of Study may exceed the 0.5 unit limit per semester, as they are required to earn a minimum of 6 units total of work experience and study credit.

Students scheduled for internship courses who do not complete the required hours will receive an incomplete grade. Work hours must be completed the following semester.

Please check which Work Study program the student is completing in the table below:

General Ed- Work not associated with CTE course/pathway

(07376)

General Ed- Work associated

with CTE course/pathway (08670, 08672)

General Ed- Work associated with CTE

course/pathway (SUMMER ONLY-

07376)

Students with IEPs

Executive Internship

Work Hours

Term Credit Hours

Work Hours

Term Credit Hours

Work Hours

Term Credit Hours

Work Hours

Term Credit hours

Work Hours

Term Credit hours

90 .25 units

100 1 unit 120 .5 units 45 .25 units

100 1 unit

180 .5 units 90 .5 units

The student and school agree to follow the district’s credit guidelines as noted in the table above.

Scheduling Guidelines DPS standard credits per period unless otherwise noted: 0.5 Term Credit Hours = 1 Fully Scheduled Period * Note: Actual scheduled minutes for October count calculations will be based on # of expected Work Hours divided by work hours multiplied by .5 (or 1.0) term units = credit hours earned. Avg. Length of period divided by .5 (or 1.0) term units multiplied by credit hours earned= OC Minutes

Page 8 of 14 Copyright (c) 2016 by Denver Public Schools, Revised 10-20-17

Page 9 of 14 Copyright (c) 2016 by Denver Public Schools, Revised 10-20-17

Phone: 720-423-1303 Fax: 720-423-1518 Email: riskmgmt_workercomp@dpsk12.org

Parental Consent for Medical Treatment Students participating in the DPS CareerLaunch Internship Program are covered by Denver Public Schools Worker’s Compensation Insurance. Denver Public Schools Risk Management Department requires a Parental Consent for Medical Treatment form signed by the parent or guardian to be on file prior to the start of a CareerLaunch Internship. On page 2 of this document is a list of the clinics authorized to provide treatment to DPS students who file a worker’s compensation insurance claim. Please note: Worker’s compensation claims need to be made within 4 business days of an internship related injury.

I ________________________________, consent to have my child, ____________________________, Parent or Guardian Printed Name Underage Child’s Name

receive medical treatment at one of the DPS designated clinics listed on page 2 of this document.

_________________________________ ________________ Parent or Guardian Signature Date

Page 10 of 14 Copyright (c) 2016 by Denver Public Schools, Revised 10-20-17

DPS Worker’s Compensation List of Health Clinics

Parent/Guardian: Please keep this list of approved DPS worker’s compensation health care clinics for your records. If you have specific questions related to DPS Worker’s Compensation Insurance, please contact the DPS Risk Management Department at 720-423-1303.

DPS Worker’s Compensation Clinics Midtown Occupational Health Services Location: 2420 W 26th Ave Building D, Suite 200, Denver, CO 80211 Phone: (303) 831-9393Accepts Walk-Ins? Yes Doctors: John Raschbacher, M.D.

Marc Steinmetz, M.D. Craig Anderson, M.D. Kirk Holmboe, M.D.

Rocky Mountain Medical Group, P.C. Locations: Location 1 -- 13650 E Mississippi Ave #120, Aurora, CO 80012

Location 2 – 730 W Hampden Ave #200, Englewood, CO 80110 Phone: Location 1: (720) 748-7072 (Tues and Thurs only)

Location 2: (303) 762-0900 (Mon, Weds and Fri only) Accepts Walk-Ins? No, please call ahead Doctor: Brian Beatty, D.O.

Concentra Location: 20 West Dry Creek Circle

Littleton, CO 80120 Phone: (303) 798-1009Accepts Walk-Ins? No, please call ahead Doctor: Kathryn Bird, M.D.

Page 11 of 14 Copyright (c) 2016 by Denver Public Schools, Revised 10-20-17

DPS Student Account Opening Form

CONGRATULATIONS!

You have decided to take control of your financial education and open a checking account with Young Americans Bank. The only bank in the world specifically designed for customers 22 and under.

This is great news because Young Americans Bank is an organization that helps you learn about saving and spending money. Opening up a bank account is an important first step in learning financial literacy.

Student Information:

Name of school attending: ______________________

____________________________________________ ____/____/___ 123 -_________________________________Student Name (Print) Date of Birth Student Account Number (Add Student ID # after 123)

____________________________________________ _______________________________________ Address Phone Number

____________________________________________ X__________________________________ __________ City, State, Zip Code Student Signature Date

By signing this document, I/we certify that: 1. I have received a copy of the Rules and Regulations and current Rates and Fees pertaining to this account.

Automated Teller Machine/Debit Card Access By signing this request, I acknowledge receipt of a copy of the Rules and Regulations pertaining to the Automated Teller Machine Program or the Debit Card Program and agree to be bound by the terms and conditions of the agreement.

X___________________________________________ Student Signature

E-Banking Access I agree to be bound by and comply with the requirements in this agreement for access to YAB eBANK. Our use of YAB eBANK further demonstratesthe acknowledgement that I have received this agreement and intend to be bound by them.

X___________________________________________ Student Signature

DPS Authorized Signer Information:

____________________________________________ 8460001099 DPS Authorized Signer Name DPS Tax ID Number (Print)

DPS Authorized Signature Date

Authorized Adult Guaranty Agreement In consideration of Young Americans Bank (YAB) honoring the checking and savings account withdrawals and deposits, and other commercial transactions in which the above named Young American engages in with YAB, I hereby agree to guaranty the performance of said student of any obligations that he/she may have in connection with all such transactions. I understand that this guaranty is unconditional and shall extend to all transactions in which he/she conducts with YAB.

X___________________________________________ DPS Authorized Signature

X___________________________________________ __________

For Bank Use Only: OFAC: Account Number: Debit Card Ordered:E-Banking Access in Logs:

Page 12 of 14 Copyright (c) 2016 by Denver Public Schools, Revised 10-20-17

DPS CareerConnect Young American’s Bank

Custodial Account Agreement

I, _________________________________________________(name of parent or guardian)

grant my child, ________________________________________________ (student’s full name)

permission to establish a DPS custodial checking account with Young American’s Bank per the terms listed below. I understand my child will receive up to three financial awards for his/her participation in the DPS CareerLaunch Internship Program.

DPS CareerConnect Custodial Account Agreement

x Denver Public Schools is the custodian of the account until the account is either closed ortransferred to my child’s name.

x The account will stay open unless my child requests the account be closed or withdraws from orgraduates from Denver Public Schools. My child may deposit additional funds in the account ifhe/she chooses to do so as long as the deposit is made in cash.

x The account is used to deposit award funds issued to students who meet award criteriaestablished by DPS CareerConnect Programs.

x Student can go to Young American’s Bank to withdraw any amount money that is available intheir account. Young Americans Bank locations are:

o 3550 E 1st Ave, Denver, CO 80206o 4800 Telluride Street, Building #5, Denver, CO 80249

x The account will not allow my child to withdraw more funds than are available in the account.x The custodial checking account provides a Debit/ATM card which can be used to withdraw cash

from an ATM or can be used to purchase items at any business where Visa is accepted. Studentswill also receive a Personal Identification Number (PIN) for use at the ATM or to make Debittransactions at a merchant.

x Account Features:o Student can withdraw money from their accounts by going to a Young Americans Bank

branch location, using an ATM card or requesting cash back after a retail purchase.o Young Americans Bank will only accept deposits made with cash or through direct

deposit (a deposit made directly into the account). No checks of any kind will beaccepted by Young Americans Bank to be cashed or to be deposited into DPSCareerConnect accounts.

o Young Americans Bank will not accept any checks that are presented for paymentagainst a DPS CareerConnect account. This means any temporary or purchased checksassociated with the Young Americans CareerConnect account will not be consideredvalid and cannot be cashed or used for payment.

x ATM Features:o The card can be used at all ATMs on the Cirrus Interbank Network/ACCEL.o Daily cash withdrawal limit is $100

� Midnight one business day to midnight the next business day (Saturday, Sundayand Monday count as one business day).

o Account balance must be a least $20 greater than the amount to be withdrawn.

Page 13 of 14 Copyright (c) 2016 by Denver Public Schools, Revised 10-20-17

o You are allowed 2 ATM withdrawals per month for free. After the second ATM cashwithdrawal, the Young Americans Bank will charge $1.50 per transaction.

o If the student uses a FirstBank or Young Americans Bank ATM, there is no terminalmachine fee. There may be a terminal fee for withdrawing funds at other ATMmachines. Students will need to check the ATM machine for fee amount.

x Debit Card Features:o If a student chooses Credit at a store or online they will have a $500 total purchase limit.

Once $500 limit is reached, student may need to wait up to 3 business days to makeadditional purchases.

o If student chooses Debit at a store or online they will only have a $250 purchase limit,including any cash back on the purchase.

x If card is lost or stolen you must report it immediately by calling 303-321-BANK or MonicaSchultz, Work-Based Learning Manager at 720-423-6450 during regular business hours. Afterhours, please call 1-800-554-8969.

o If you don’t call within two business days you could be liable for any unauthorizedtransactions up to $500. Please read the Young Americans Bank Account Rules andRegulations for more information.

x If the student loses the card or its stolen there is $5 reissue fee.x A bank account statement is available per request from the DPS CareerConnect office. Please

contact Monica Schultz at 720-423-6450 or monica_schultz@dpsk12.org to request a copy ofthe student’s bank statement.

x The student will access the account using his/her student ID number. The student will also setup a PIN to access the account securely.

I have read and agree to comply with the DPS CareerConnect Custodial Account Agreement.

___________________________________________ ________________________ Student’s Full Name Student ID#

___________________________________________ Student’s School

___________________________________________ ________________________ Student’s Signature Date

___________________________________________ Parent/Guardian’s Name

___________________________________________ ________________________ Parent/Guardian’s Signature Date

Page 14 of 14 Copyright (c) 2016 by Denver Public Schools, Revised 10-20-17

CAREERLAUNCH INTERNSHIP PROGRAM PARENT PERMISSION TO TRANSPORT STUDENT

I, __________________________________________ (name of parent/guardian) grant my

permission to allow my child ______________________________________________ (name of

child) to be transported by the staff of ______________________________________ (name of

company/organization) for the purposes of my child’s participation in the Denver Public Schools

CareerLaunch Internship Program.

I understand my child will be transported from the internship worksite to offsite locations

within the Denver metro area. I understand that any adult who transports my child has met the

guidelines set out in Denver Public Schools Board Policy EEA-RT, requiring anyone transporting

students to submit a Motor Vehicle Record, proof of vehicle insurance and a copy of a valid

driver’s license to the school district.

I also acknowledge that anyone who transports my child has undergone a criminal background

investigation by Denver Public Schools and been cleared by the DPS Human Resources

Department.

1. YES, I allow my child to be transported by his/her internship company’s staff for the

purposes of participating in internship related activities.

_____________________________________________________ ____________

Parent Signature Date

2. NO, I do not allow my child to be transported by his/her internship company’s staff for

the purposes of participating in internship related activities.

_____________________________________________________ ____________

Parent Signature Date

_____________________________________________________________________________________________ Office Use Only: Submit copy of permission form to CareerConnect Office.