Internships and Work Experience | ConnectAble - Web Design & Adult Education

Let's get to work!

Looking for a great work experience? Do you like learning on the job?Are you between the ages of 16 and 24 and wanting to get into a particular industry? Start here!

*2023-24 WEX Application

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Student ID

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Date Submitted:

Name:(Required)

Please carefully type your legal name.

Are you a currently a student at any high school in the state of Indiana?(Required)

Yes

What is the name of the organization in which you want to work?(Required)

In case of an emergency, what is your preferred hospital?

Franciscan

St. Vincent

IU Health

I don't have a preference.

Other

What is your physician's name?

Physician's Phone Number

Student Goals - I would like to:

Please select the goals you would like to accomplish with us. Check all that apply.

Improve my basic academic skills.

Earn a US High School Equivalency (HSE) diploma.

Get a job.

Keep my current job

Enroll in career-related training.

Enroll in postsecondary education (college/university).

Become a citizen of the US.

Increase my involvement with my child’s education and literacy.

If you have any other goals or needs, please type those here, as well as anything else you would like our staff to know about you.

Social Security Number:

We do not require you to provide your social security number, but providing it helps us to track your accomplishments as well as any resources we might be able to provide for you. As always, we keep all of our data secure.

Address:(Required)

In which county do you live?(Required)

Please upload a favorite photo of yourself so that we can use it for your student profile.

Because we are using this for your student ID, please include only your head and shoulders in the image.

Max. file size: 64 MB.

Are you a US Citizen?(Required)

We accept ALL students, regardless of which citizenship status you choose. Choosing NO will not prevent you from enrolling with us.

Yes

Veteran Status:(Required)

Please select the statement that describes you.

I am not a veteran

I am a veteran with less than 180 days of active duty.

I am a veteran with at least 180 days of active duty.

I am a veteran who served in a war or expedition with an authorized campaign badge.

Country of Birth:(Required)

Mobile Phone Number:(Required)

We communicate important messages to students via text message. If you do not currently have a mobile phone, please list a mobile phone number of a trusted family member or friend so that you can receive messages.

Home Phone Number:

You can leave this blank if you do not have a home phone number.

Email:(Required)

Enter an email address you can access easily and check frequently. Please make sure that you only use ONE email account, and that the email account belongs only to you, as email accounts cannot be shared.

Date of Birth:(Required)

Age:(Required)

Gender:(Required)

Male

Female

Non-Binary

Please list any other legal names you have had in the past.

For example, if you are married and your last name has changed, list your previous last name here. If you have never had a different name, leave it blank.

Ethnicity:(Required)

NOTE: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race, refers to Hispanic ethnicity.

I am Hispanic.

I am NOT Hispanic.

Race:(Required)

African American

Asian

American Indian

Pacific Islander

White

Please select all that apply.

Name of Emergency Contact:(Required)

Who can we contact if we cannot reach you?

Emergency Contact's Phone Number:(Required)

Employment Information

Choose the statement that best describes your employment status.(Required)

I am EMPLOYED.

I am currently NOT EMPLOYED, but I am able to work.

I am NOT IN THE LABOR FORCE, as I am not working, not able to work, or not looking for a job.

I have been UNEMPLOYED FOR MORE THAN 26 WEEKS.

I am EMPLOYED, BUT MY JOB IS BEING TERMINATED.

Employer/Company Name:(Required)

Date of Hire:(Required)

If you do not remember the exact date you were hired, you can choose the date that is your best estimate of when you were hired.

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Employer Phone:

Educational Information

Educational Status:(Required)

Please check the highest level of education you have completed.

Last Grade Completed:(Required)

Please select the highest grade level (1-12) that you completed. *If you have completed education beyond high school, choose 12 as your last grade level completed.

Last School Attended:(Required)

Please type the name of the last school you attended.

Previous Schooling Location:(Required)

Where did you complete most of your previous education?

Inside the US

Outside the US

School Attendance Status at Entry:(Required)

Select the option that BEST describes your current school situation:

NOT currently attending school, did NOT finish high school, and OLDER THAN 17 years old

NOT currently attending school, YOUNGER THAN 18 years old

NOT currently attending school, already have a High School Diploma, HSE diploma, or GED.

I am currently attending school, GRADES K-12.

I am currently attending an ALTERNATIVE SCHOOL.

I am currently attending COLLEGE.

Household Information

Method Found:(Required)

Please select the statement below that best describes how you first learned about our program.

What is the name of the person who referred you to us?(Required)

Demographics

Do you any have physical, mental, or learning impairments?(Required)

Yes

Do you live in an urban area (inside city)?(Required)

Yes

Do you live in a rural area (outside city)?(Required)

Yes

Do you currently receive public assistance?(Required)

Organizations such as Temporary Assistance For Needy Families (TANF), SNAP (food stamps), SSI and WIC are examples of public assistance.

Yes

Do you have a low level of income?(Required)

A YES response means that you do not believe you have enough income to pay your bills.

Yes

Are you a displaced homemaker?(Required)

A YES response means you were previously a stay at home mom or dad, but you are now seeking work due to a change in your household situation.

Yes

Are you a single parent?(Required)

Yes

Are you a dislocated worker?(Required)

A YES response means that you were laid off or lost your job due to the company moving away.

Yes

Are you a dependent yourself, or do you claim to have dependent(s) in your household?(Required)

A YES response means that either someone claims you as a dependent OR you claim to have dependent(s) yourself.

Yes

Household Size: How many people live in your household, including yourself?(Required)

Please enter a number greater than or equal to 1.

Annual Family Income (How much is your family income in one year?)(Required)

We accept ALL students, regardless of family income.

Are you currently, or have you ever, been in foster care?(Required)

Yes

Are you considered to be homeless, or are you a runaway?(Required)

A YES response means that you DO NOT have a permanent, regular nighttime residence (other than a vehicle, a shelter, or temporarily staying with a friend).

Yes

Do you speak a language other than English at home?(Required)

Yes

What is the language you first learned as a child?(Required)

We understand that there are some circumstances that make it difficult to come to school or get a job. We have many resources that can help you with those difficulties. Please select any of the statements listed below that apply to you, because we may be able to help!(Required)

Select all statements that apply to you.

Are you a migrant/seasonal farm worker?(Required)

No, I am NOT a migrant farmworker.

I am a migrant farmworker.

I am a migrant AND seasonal farmworker.

I am the dependent of a migrant farmworker.

Are you an active military member?(Required)

No, I am not active military.

Yes, I am active military.

I am the spouse of someone who is active military.

Are you involved in a Vocational Rehabilitation agency?

If you don't recognize any of these choices, select NO or UNKNOWN.

Do you utilize Wagner Peyser Employment services?(Required)

Wagner-Peyser employment services are federally-funded Unemployment Services, which connects employers with job seekers.

Unknown

Yes

Ex-Offender:(Required)

Have you ever been convicted of a crime?

Unknown

Yes

Cultural Barriers to Employment:(Required)

Do you have any cultural barriers that affect your job opportunities?

Unknown

Yes

INTERLOCAL ASSOCIATION WORK EXPERIENCE INTERNSHIP

LIABILITY WAIVER & ACKNOWLEDGEMENT OF RISK: COVID-19

I herby acknowledge that I have chosen to participate in a work experience program, organized and operated by Interlocal Association. I understand that COVID-19 has been declared a worldwide pandemic by the World Health Organization and that it is extremely contagious and is spread mainly from person to person contact. By signing this waiver, I acknowledge that by participating in the work experience program I will be required to follow Reopen Indiana policies and guidance set forth by Governor Holcomb. I voluntarily agree, to assume the risk and accept sole responsibility that I may be exposed to or infected by COVID-19 by participating in the work experience program and that such exposure or infection may result in personal injury, illness, permanent disability and death. I also exempt, release and indemnify Interlocal Association, its board members, instructors, employees, students, fimders, host worksites and volunteers from any and all cause of action, liability claims, and demands whatsoever. I will not hold Interlocal Association liable for any injury (including but not limited to: personal injury, disability and death), illness, damage, loss, claim, liability or expense of any kind that I or my family may experience or incur in connection with my participation in the work experience program. I understand and agree that this release includes any claims based on the actions, omissions, or negligence of Interlocal Association, its employees, board members, participants, funders, host work sites, volunteers, and representatives whether a COVID-19 infection occurs before, during, or after participation in any Interlocal Association work experience or other progrannuing service.

Consent to Release of Information:(Required)

YES, I HAVE FULLY READ, UNDERSTOOD AND AGREE TO IBE CONTENTS AND CERTIFY THAT THIS ACT IS OF MY OWN FREE WILL AND DEED.

Photo Release

We love to celebrate success with our students, and we often do that through pictures, articles, slideshows, and other fun media. In order for you to participate in that, we will need your permission to use your photo.

I grant this adult ed program, its representatives and employees the right to take and/or use provided photographs of me in connection with documents and promotional materials published by the same. I authorize this adult ed program, its representatives and employees, to use and publish the same in print and/or electronically. I agree that Area 30 Adult Education may use such photographs of me, with or without my name, for purposes including training and instruction manuals, promotional materials, and electronic documents.

Student Photo Release:(Required)

Yes, I agree to the above photo release statement.

No, I do not agree to the above photo release statement.

INTERLOCAL ASSCOIATION WPRK EXPERIENCE/INTERNSHIP RULES AND CODE OF CONDUCT

INTERLOCAL ASSOCIATION WORK EXPERIENCE/INTERNSHIP RULES AND CODE OF CONDUCT ► I will make sure I understand the rules and policies of my worksite, will abide by them, and will dress appropriately for the job. ► I will call the Career Services Advisor (CSA) no later than an hour before I am scheduled to work ifI am ill or if an emergency prevents me from going to work. ► I will be on time for my job, will attend every day, keep lunch times, and breaks within the time limits set by my worksite. ► I will try to perfonn my job well, and will inform my supervisor if I am having prnblems doing it. ► I will be evaluated on my dependability, productivity, attitude, and performance. ► If problems occur that would prevent me from continuing the job, I will immediately contact the Interlocal CSA. ► I will notify the Interlocal CSA if I have a change of address or phone number. ► I will immediately notify the Interlocal CSA ifI am offered a job. DISCIPLINARY ACTION POLICY

A violation includes but is not limited to the following: Refusal to work as assigned Use of threatening or inappropriate language, or any disrespectful conduct Leaving the worksite without infonning the supervisor Sleeping Boisterous or disruptive activity Unauthorized use of worksite equipment No underage smoking is allowed
Resulting Disciplinary actions are: 1st offense -Verbal warning with a written notice in permanent file 2nd offense -Removal from current worksite and may not be assigned to future worksites
Offenses that are grounds for immediate dismissal from the Interlocal youth program: Reporting to the worksite under the influence of illegal drugs or alcohol Using or possessing illegal drugs or alcohol while at the worksite Possession of weapons Fighting Theft or willful damage to materials or equipment Falsification of documents Sexual or otherwise unwelcome harassment

Typing your name in the field(s) below will constitute your electronic signature(s) for the above provided information. Please verify that all information is accurate and that you agree before you sign. Applicants who are under 18 years of age will require a parent/guardian signature as well.

Student Signature(Required)

Please type your full legal name, as this will serve as your electronic signature. This signature acknowledges that the information provided in this form is correct and that you agree to the releases contained in this registration form.

Date:(Required)

Parent Consent to Release of Information:(Required)

As the parent/guardian with legal responsibility for the minor named above, do consent and agree to his/her release above and for myself, my heirs, assigns and next of kin. I release and agree to indemnify and hold harmless Interlocal Association from any and all liabilities incident to my minor child's involvement or participation in these programs provided above.

Parent/Guardian Signature(Required)

Parent/Guardian, please type your full name, as this will serve as your electronic signature. This signature acknowledges that the information provided in this form is correct and that you agree to the releases contained in this registration form.

Date:(Required)

WHO ARE WE?

ConnectAble is a nonprofit organization that was founded when a small team of educators who were passionate about the mission of adult education joined forces with a team of technology experts who wanted to help. Together they formed ConnectAble, which has now, just four years later, grown to a large team of educators and tech experts, helping adult education organizations across the country!

It is the mission of ConnectAble to make education accessible to all adult students, allowing them to live more fulfilled lives, while giving educators the gift of more time with those students.

The technology and other tools and resources that come with a ConnectAble membership were specifically created for adult education, and we have helped programs across the nation to find and connect with more students, boosting enrollment and retention. Because our technology was built specifically with the adult student in mind, it is fully translatable and easy to use for students of all abilities and languages.

Programs that use ConnectAble also see improved performance metrics as they keep students engaged, all the way from enrollment to employment. Educators have immediate and easy access to the student data they need, giving educators back the valuable time they need to work with students and not spend their time chasing a paperwork trail.

Want to learn even more about how ConnectAble can help? Keep reading, then schedule a time to talk with us!

WE OFFER SOFTWARE, BUT A CONNECTABLE MEMBERSHIP OFFERS SO MANY MORE RESOURCES THAN THAT!

Because we were founded by adult educators with years of experience, we have walked in your shoes, and we understand your needs.

While we do offer top-notch technology to help with your common adult ed tasks, the benefits of your ConnectAble membership don’t stop there!

Members also have access to a whole suite of other resources to help you, including curriculum-writing and workforce support, large and small group professional development, marketing materials from our print shop, consulting services, and more, all provided by team members with years of experience in the field. ConnectAble members have an entire team of people available to them at flexible times for support.

Because ConnectAble also has an arm that serves the business sector, we are in a unique position to share the mission of adult education with your local employers who want to support your program, leading to funding donations and/or strategic partnerships.

Getting employers involved has helped our members to have better-funded, thriving adult education programs, as well as a healthier local economy. Let us help you connect!

MEMBER BENEFITS

Automated, translatable, Student-Friendly Registration and Student Information System
Collection and distribution of Student Success Stories
Outreach tools so you never miss a chance to collect contact info for interested students.
Graduation tools and support
Integration into state reporting systems
Discounted promotional materials and printing from our print shop
One-click communication tools for one-to-one or group messaging
Professional development for individuals, teams, or all staff
Discounted rates for website custom development and optimization
Help to form strategic partnerships with employers and businesses near you
Experienced support team with flexible availability
Donations and scholarships available to help you pay for your membership

Let's get to work!

*2023-24 WEX Application

Employment Information

Educational Information

Household Information

Demographics

INTERLOCAL ASSOCIATION WORK EXPERIENCE INTERNSHIP

Photo Release

INTERLOCAL ASSCOIATION WPRK EXPERIENCE/INTERNSHIP RULES AND CODE OF CONDUCT

WHO ARE WE?

WE OFFER SOFTWARE, BUT A CONNECTABLE MEMBERSHIP OFFERS SO MANY MORE RESOURCES THAN THAT!

MEMBER BENEFITS

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