Sandhills Community College WBL FORM 2 Rev. 2020
Student Name
Employer Address
Hours Required
Supervisor Phone
Supervisor Email
Sandhills Community College and the cooperating employer/agency agree to observe placement procedures and employment
practices which conform to all federal, state, and local laws and regulations (including nondiscrimination toward any participant or
employee because of race, color, religion, sex, veteran's status, disability, or national origin). The following statements constitute
the Agreement on which participation in the Work Based Learning Program through WCE at Sandhills Community College is based:
College Responsibilities
1. Provide consultation and coordination among the student, the employer, and the college.
2. Determine if the worksite is appropriate and conducive to the participant’s learning.
3. Review and approve the job description or learning objectives.
4. Conduct on-site visits with students and their immediate supervisors.
5. Determine a grade for the work experience and award college credit based on the student's performance.
Employer Responsibilities
1. Provide at least the minimum hours of employment as indicated above.
2. Compensate student at a level consistent with regular employees in a similar training situation.
3. Identify a qualified employee to serve as the immediate supervisor, who will mentor the student and will complete all required
forms, including the student’s time sheet and evaluation.
4. Permit on-site visits by a College representative.
5. Notify the College of any issues or concerns regarding the student.
6. Provide Workers’ Compensation liability Insurance as applicable according to state law.
7. Give permission to use employer's name in co-op marketing/promotional materials.
8. Adhere to the Fair Labor Standards Act. Assure a safe and healthy work environment.
9. Encourage the student to continue his/her higher education to completion.
Student Responsibilities
1. Report punctually and regularly for work. Notify the employer promptly if you are unable to work for any reason.
2. Adhere, at all times, to the employer's work rules and regulations.
3. Meet with your supervisor within the first week to review the job description or develop learning objectives that align with your
program of study.
4. Inform the college's Financial Aid Office of the student’s co-op employment and report wages earned during the work
experience, if appropriate. Understand that federal and state law prohibits a student from collecting unemployment benefits
after a paid co-op work experience has ended.
Statement of Cooperation
I have read, fully understand, and agree to abide by the responsibilities stated in this Agreement, and I will strive to make this a
successful learning experience.
Student Signature Date Employer Signature Date
WCE WBL Program Coordinator
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