Southwestern College CTC/Student Employment Services Cesar E. Chavez Bldg. 68 - 208 900 Otay Lakes Rd. Chula Vista, CA 91910 Contact: Julie Swanson jswanson@swccd.edu

WORK EXPERIENCE EDUCATION
AGREEMENT

SECTION 1: Type of company/agency: Business Non-Profit

Name of Company/ Agency:

Company Address:

City, State, Zip Code and Telephone No:

Name of Agency/ Supervisor:

Agency/Supervisor Email Address:

Students Name (Last, First):

SWC ID:

Student Email Address:

Course/Section Units/Semester/Year:

Name of Instructor:

SECTION 2 OCCUPATIONAL WORK EXPERIENCE EDUCATION PROGRAM STATEMENT

The student will comply with the Work Experience Education program guidelines and regulations. The agency and the college will provide necessary supervision and counseling to ensure that the student receives appropriate educational benefits from this work experience. The instructor will visit the student placement site; consult with the agency regarding the student’s job performance and grant academic credit for successful completion of the internship. It is understood the college and agency will, as required by law, comply with all appropriate federal and state regulations. Pursuant to Labor Code Section 3368, workers’ compensation coverage is provided for students enrolled in work experience classes through the Southwestern Community College District. The Agency reserves the right to terminate a student due to unsatisfactory progress, or failure to meet work standards, at which time the college will be notified. The college reserves the right to terminate a student who may become ineligible, at which time the agency will be notified. The undersigned agree with the validity of the job-oriented learning objectives listed below.

Agency Representative Signature / Date Student Signature/ Date Instructor Signature/ Date

SECTION 3	Employer/Agency ONLY

LEARNING OBJECTIVES Learning Objectives are specific, measurable, limited to a single definite result, and have a completion date within this semester. Learning Objectives help to ensure that you, your job site supervisor /manager, and your Work Experience Instructor are all iin agreement with what you are there to learn while you are on the job this semester. JOB-ORIENTED LEARNING OBJECTIVES Each semester, a student enrolled in CWEE is required to identify new learning objectives. They should be specific, measurable, and within the student’s ability to accomplish during the semester. The student formulates the objectives, with the assistance and approval of both the company’s Supervisor and SWC Instructor. Should an objective require revision anytime during the semester/session, the instructor must be notified.	Were The Listed Objectives Achieved? Check Box Limited Satisfactory Above Average Outstanding
1. Learn to
2. Learn to
3. Learn to
AGENCY REPRESENTATIVE COMMENTS:

SECTION 4: SUMMARY STATEMENT OF HOURS & OBJECTIVES: This internship is: Unpaid Paid (To be completed by Instructor & Company Supervisor at the end of the semester and/or work experience hours completed)
We verify that the above student has worked from:______/_____/______	to ______/	_____/	______ Total______hours and has satisfactorily achieveddthe learning objectives. Month Day Year	Month	Day	Year

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Company Supervisor Signature	Date	Instructor’s Signature	Date

Work Experience Instructors please submit this form by the suggested deadline emailed to you. Thank you Rev 8/2023 WWE Forms jswanson