JSCC WBL Form

JSCC Work-Based Learning - Workbook Form - Page 1 of 20

Student Name: Student ID Number: Curriculum Program: Course (WBL ___ Section ___): Semester: Year: Employer: Employer Address: Employer Phone Number: Supervisor Name: Faculty Coordinator Name: WBL Coordinator Name: MLO's Approved By Date (MM/DD/YYYY): Completed Workbook Due By (MM/DD/YYYY):

Note: MLO must be developed within the first two (2) weeks of employment if not before.

The WBL Coordinator is the person who works directly with the student.

The Faculty Coordinator is responsible for developing MLOs.

Updated December 2024