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WBL Application
Student participation in WBL is contingent upon the submission and approval of application by the district's CTAE Coordinator.
(updated 9.19.2023)
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
School email account (
00000@cpehs.org
)
*
Your answer
Date of Application
*
MM
/
DD
/
YYYY
Application Site
*
Choose
Bulloch
Camden
Candler
Coffee
Colquitt
Evans
Glynn
Grady
Jeff Davis
Liberty
Long
Lowndes
Screven
Vidalia
Wayne
STUDENT CONTACT: Cell phone number (use 000-000-0000 format -- or enter 229-000-0000 if there is NO cell phone)
*
Your answer
Select the correct WBL Segment (Course) Requested (check all that may apply if you wish to have multiple segments) ******* YOU MUST RE-APPLY EACH TIME FOR THE NEXT COURSE ******
*
WBL I (1st Time Taking WBL)
WBL II (2nd Time Taking WBL)
WBL III (3rd Time Taking WBL)
Course Number (Leave Blank)
Your answer
Birthday
*
MM
/
DD
/
YYYY
Emergency Contact Name
*
Your answer
EMERGENCY CONTACT: phone number (use 000-000-0000 format -- or enter 229-000-0000 if there is NO cell phone)
*
Your answer
Place of Work
*
Your answer
WORK PHONE: Offical phone number for the worksite (use 000-000-0000 format -- or enter 229-000-0000 if there is NO cell phone)
*
Your answer
Work Address (123 Main Street, City, ST ZIP)
Your answer
Supervisor's Name
*
Your answer
SUPERVISOR'S CONTACT NUMBER: (use 000-000-0000 format -- or enter 229-000-0000 if there is NO cell phone)
*
Your answer
Start Date (Choose the first day of the month that you started)
*
MM
/
DD
/
YYYY
Job Title
*
Your answer
What career do you wish to pursue after graduation?
*
Your answer
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