2023 Teacher Externship Program - Workplace Host Interest Form

Build the Workforce of Tomorrow, Today - 2023 Teacher Externship Program

Thank you for your interest in the hosting a Teacher Extern in your workplace this summer! Please complete the following information and our team will be in touch shortly to schedule a time to visit with you about the program.

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* 1. Company Name

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* 2. Who will be your company's primary Point of Contact regarding the Teacher Externship Program?

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 3. Please provide a brief description of your company (or a link to the company webpage).

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* 4. How many teacher externs do you think your company would like to host? Please note, the cost to host is $3,500 per extern, which includes a stipend for the participating teacher.

Other (please specify)

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* 5. Externships are designed to last for two weeks, 32 hours per week. Weeks can be concurrent or take place at different times during the designed time period. All externships must take place between June 5 and July 28. Please indicate below which weeks your company could host an extern.

June 5 - 9

June 12 - 16

June 19 - 23

June 26 - June 30

July 10 - July 14

July 17 - 21

July 24 - July 28

Undecided at this time

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* 6. Externships are 32 hours each week, over four days. Which schedule would you prefer your externs work?

Monday - Thursday

Tuesday - Friday

Undecided at this time

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* 7. All externships should take place between the hours of 7:30 a.m. and 5:30 p.m. Do you anticipate your company will be able to accommodate this daily schedule?

Yes

If no, please specify

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* 8. Please detail any required safety equipment or safety precautions that your company requires.

	Company Provided	Required
Hard Hat	Hard Hat Company Provided menu	Hard Hat Required menu
Steel Toe-Boots	Steel Toe-Boots Company Provided menu	Steel Toe-Boots Required menu
Safety Googles	Safety Googles Company Provided menu	Safety Googles Required menu
Masks	Masks Company Provided menu	Masks Required menu
COVID-19 Vaccine	COVID-19 Vaccine Company Provided menu	COVID-19 Vaccine Required menu

Other (Please detail and share whether this equipment is provided by the company). You may also share additional detail for answers provided above in this space.

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* 9. Expected dress attire for your extern(s)?

Business Professional (e.g., Suit, Dress, Pants Suit, Sports Jacket, Dress Pants, Dress Shoes)

Business Casual (e.g., Button-down, Polo, Sleeved Shirts, Khakis, Dress Pants)

Casual (e.g., T-Shirt, Sneakers, Jeans)

Other (please specify)

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* 10. Expected externship business environment?

Estimated Hours Spent Walking or Standing? (Range: 0 - 64)

Estimated Hours Spent at a Desk? (Range: 0 - 64)

Estimated Hours Spent Working Indoors? (Range: 0 - 64)

Estimated Hours Spent Working Outdoors? (Range: 0 - 64)

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* 11. The Chamber will help you design your externship experience, however, what type of externship experience might fit within your organization?

Integration Experience: The teacher extern is integrated into a team, or department, to assume specific duties/projects

Exposure Experience: The teacher will gain insight into a business or industry by shadowing executives, managers, and teams in multiple departments.

Our extern(s) will have an opportunity to participate in integration and exposure experiences.

Undecided at this time.

Comments

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* 12. If you already know what type of externship you will offer, briefly describe it here. Example: Externs will be able to shadow multiple positions and learn about various job responsibilities of our staff. Day 1 will be spent working with the HR department. Day 2 will be working with our software program. Day 3 will be spent shadowing our Production Manager.

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* 13. Additional Information, Special Requests, or Preferences, if applicable (e.g., please note if you would prefer an Extern from a specific school district, etc.)