Wisenbaker Practicum Rotations I and II

Course Handbook

Risa McCann, Teacher

Humble I.S.D.

Rmccann@humbleisd.net

http://humbleisd.net/Page/82992

Revised Fall 2017

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Wisenbaker Practicum Rotation

The Wisenbaker Practicum Rotation Program was established as a partnership between Humble ISD and the Wisenbaker Company. The program was developed so that junior and senior level students from Humble ISD schools could experience the many varied career opportunities within the business.

Students will spend part of their school day at the business and have the opportunity to train in all areas of the business. The employees at Wisenbaker will train the students in all aspects of their jobs. Students will also learn employment skills they can use in any career throughout their lifetime. These work-based skills are not taught in the regular academic classrooms yet are the very life-line of successful career paths. The staff of Wisenbaker is committed to giving back to the community and has graciously committed themselves to educate today’s youth.

On behalf of Humble ISD, we thank the Wisenbaker Company for its interest in the futures of today’s youth and support of this school-business partnership.

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Parent/Guardian and Student:

Please sign and return the following attached forms to the program instructor, Mrs. Risa McCann, by Friday, August 25, 2017.

Parent Letter General Course Information Student Participation Approval Letter (parent copy) Compliance to Federal Law Statement 2017-2018 Course Syllabus Student Cover Sheets and Performance Appraisals I and II

Forms to be signed and returned

Student Participation Approval Letter School District Release of Liability School District Medical Authorization Student Dress Code Policy Agreement Non-negotiables Training Plan Agreement

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Risa McCann, Teacher

Wisenbaker Practicum Rotations I and II, Humble ISD

Dear Parent/Guardian,

Your son/daughter is enrolled in the Wisenbaker Practicum Rotations I and II course, an exciting and productive program that is a partnership between the Wisenbaker and Humble ISD. Students will have opportunities that are not normally afforded them in a regular classroom setting. Having the Wisenbaker sites as training facilities makes the training realistic. Your child will have the opportunity to train in different areas of the company. There are currently several industry certifications available for the students to earn. At the end of the school year, your son/daughter will be able to apply for a position at Wisenbaker, or use this training on job resumes and college applications, as if they had worked a year in the business world. Also they will hopefully have a clearer picture of their future career path. The students will earn 3 credit hours for the course.

If after reading the information in this handbook, you have a comment or question, please email me, my address is Rmccann@humbleisd.net.

Sincerely,

Risa McCann

Humble ISD Teacher

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General Course Information

Transportation

Students are transported from their individual high schools to Wisenbaker work sites by HISD School bus every day free of charge. Individual student driving to the worksite is not permitted.

Students that miss the bus to the CATE Center will be required to do the following:

1. Go directly to their Assistant Principal/Counselor/Secretary’s office.

2. Ask the Campus representative to notify Mrs. McCann via phone call/email of the student’s location.

3. The student will be required to stay with the Campus representative and may choose to do their school work or any tasks assigned by the School representative. Sleeping during this time is never allowed.

4. The student will be required to write a note to their training station mentor about the absence and hand-deliver it the next training day.

5. Any student that “misses the bus” more than one time per school year may be subject to dismissal from the program.

6. The student is counted absent as per HISD policy!

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Absences

All Humble ISD policies for absences apply to this course.

Please schedule doctor’s appointments, etc. at another time during the day if possible. Students should contact the instructor by calling her cell phone or sending a text as soon as the absence is determined, or by 7:00 AM. Failure on the part of the student to contact the instructor for the first absence will result in a lowered evaluation score; the second failure to notify the instructor will result in a discipline referral; and the third failure to notify the instructor will result in removal from the course.

School-related activities are announced in advance, so please alert the course instructor if absence is related to school.

Students will earn 25 points a day, 4 days a week for attending class, dressing professionally, wearing their nametag and a smile, arriving and participating in their station activities in a timely manner. Students will earn a zero for all absences unless the absence is excused by the campus (DV, SR, PCN). Students will also be in violation of the course procedures, as spelled out in the Course Handbook, for not notifying Mrs. McCann of an absence either prior to the absence or the early morning of the absence. Participation in W.B.S. is similar to that of a paying job. If a worker does not show up and does not notify the employer of the absence he is subject to dismissal!

Curriculum and Training

Included in this handbook is the course outline. This is a year-long course that yields 3 elective credits and requires a 3 hour time block in the student’s schedule. During the first six weeks of the fall semester, the class will meet at the Career and Technology Center on Will Clayton Parkway.

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Students will be transported from their individual high schools to the CATE Center by HISD School bus every day. Once rotations begin at Wisenbaker the students will be bused from their schools to the Wisenbaker Practicum sites. Students will be transported back to their campuses in the afternoon in time for them to be dismissed at 2:45 PM.

The emphasis of study the first six weeks will be corporate history of the Wisenbaker Company, the structure of the company; professional ethics, workplace harassment, workplace safety, interpersonal communication and customer service skills in order that your son/daughter may be a more successful trainee. Time will also be spent addressing the student expectations of Wisenbaker, Humble ISD and the instructor.

After this time of orientation and training, our normal week will consist of the students training at their stations Monday through Friday, with Thursdays spent in the classroom at the CATE Center on Will Clayton Parkway. Students will have the opportunity to train and work in the many areas within the company during the course. The students are not paid employees of Wisenbaker. This opportunity will also hopefully open doors for summer, part-time and post-secondary employment. Students will dress and act professionally as they work side by side with employees.

Student training stations at the Main Building will include:

Human Resources

Corporate Receptionist

Inside sales (I.S.R.)

IT

Quote and Release (Q. and R.)

Expediting

Every effort will be made to comply with the student’s departmental requests. The teacher will make the final decision as to the department in

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which the student will be best suited. Students are not allowed to make rotation changes with other students.

Meals/Snacks

Students must eat before arriving at W.B.S. A student is never to assume food at W.B.S. is free or available to be eaten by them. If food is offered by a W.B.S. mentor it is acceptable to enjoy the offered food, otherwise – students are not to eat or to ask for food or beverages!! Items from the vending machines in the employee may be purchased at the end of the shift each day.

Cell Phones

The use of cell phones is prohibited by Humble ISD during class time. Disciplinary action will be taken if a student is found using their cell phone on the Wisenbaker property. Repeated use of a cell phone will result in dismissal from the course. It is suggested that students wear a watch in order to keep track of time.

Dress Code

A simple wrist watch is suggested for time awareness! One ring per hand and absolutely no facial jewelry allowed. Fingernails are to be trimmed short just beyond the fingertip, filed smooth. Fingernail polish is to be clear in color, if worn at all.

Male students may not display facial hair.

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Personal hygiene and appearance is an important part of the student’s daily grades. Students are to bathe, shampoo and groom themselves daily. The HISD Dress Code policies will be strictly enforced!

Each day an individual appearance and name tag inspection will be held before students are released to the worksite.

Grades

Grades for this class are determined by the following criteria for each marking period:

30% - Training Station Evaluation – evaluation information provided by Wisenbaker mentors via the Student Performance Appraisals

30% - Course tests and course projects

40% - Daily grades: class work and assignments, plus a participation grade will be based on daily appearance, nametag, personal hygiene, and professional appearance and attitude

Supplies

The student is required to provide 1 box or package of 8 to 10 business appropriate notes (blank inside) by Friday, September 1, 2017.

Through the Wisenbaker Practicum Rotations I and II program students can:

Learn basic transferable skills needed to work in business world

Get hands-on work experience

Get a jump start on college by acquiring real-world work skills

Learn job hunting techniques

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Build on-the-job language skills

Learn in a fun and never boring way

Develop strong interpersonal employee skills

Become familiar and comfortable with the business concepts and the business community

Experiment with different career areas to give them the experience to set career goals

Develop professionalism

Develop leadership skills

Student Participation Approval Letter

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This handbook contains 2 copies of the Student Participation Approval Letter. One copy is to be kept by student and the second copy is to be returned to the course instructor as a part of the school records.

As a student enrolled in a training internship, you understand that:

1. The teacher will approve all training station placements.2. Dismissal from a training station for insubordination, refusal to work,

poor work habits or poor attitude, will result in a failing grade for that 9 week marking period.

3. If a student is terminated for dishonesty, theft, immoral conduct, or deviating from the Wisenbaker company policy, the student will be removed from the Wisenbaker Practicum Rotations I and II course immediately.

4. Students must notify the teacher by 7:00 AM if they are to be absent due to illness from school. Attendance will be verified with the student’s campus. Failure to notify teacher will result in lowered evaluation scores.

5. Students must wear the appropriate uniform each day and follow HISD and Wisenbaker Dress Codes.

6. All Humble ISD School rules apply at the Wisenbaker sites.7. All Humble ISD policies are applicable while students are attending

program functions.8. Students should display a professional attitude, loyalty and

confidentiality (if necessary) towards the Wisenbaker Company.9. If problems persist in the classroom or at the training station, students

can be removed from the program at mid-semester. Removal will be made after consultation with the student and their parents/guardians.

10.Enrollment is for one year and yields 3 elective credits.11.Student must be a junior or senior on the first day of school.12.Students are required to subscribe to REMIND. This is done by texting

the message bd962f to 81010 and reminders will be sent out by the

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instructor using this service. Parents are also encouraged to sign up for REMIND by texting the message to the given phone number.

Parents and students, please read, sign and date below. Two copies of this agreement are included in this packet so that one can be kept by student in their binder and the other copy returned to the instructor.

I have discussed my son/daughter’s enrollment in the class and I approve of their choice. I have read and I understand the above information. In addition, I understand and agree that I am to communicate with the HISD teacher concerning problems at the training station, rather than talking directly with the company managers or supervisors.

****PARENTS AND STUDENTS, please sign and date the copy of this letter that is included at the back of the handbook. This copy is for your records and information.

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Compliance to Federal LawIt is the policy of Humble Independent School District to comply fully with the nondiscrimination provisions of all

Federal and State laws and regulations by assuring that no person shall be discriminated against on the basis of sex,

disability, race, color, age or national origin in its educational and vocational programs, activities, or employment as

required by Title IX, Title VI, Section 504 of the Rehabilitation Act of 1973, and the Americans with Disabilities

Act.

This notice is provided as required by Title II of the Americans with Disabilities Act of 1990 and Section 504 of the

Rehabilitation Act of 1973. Questions, complaints, or requests for additional information regarding the ADA and

Section 504 may be forwarded to the designated ADA and Section 504 compliance coordinator.

El Distrito de Humble cumple plenamente con las provisiones de leyes y regulaciones federales y estatales de no

discrimina asegurando que no discrima ni por sexo, incapacidad, raza, color, edad ni origen nacional en sus

programas educacionales y vocacionales, actividades, ni empleo como requerido por Título IX, Título VI y la

Sección 504 de la Acta de Rehabilitación y la Acta de Americanos Incapacitados (ADA).

Esta noticia se provee según el Título II de la Acta de Americanos Incapacitados (ADA) de 1990 y la Sección

504 de la Acta de Rehabilitación de 1973. Preguntas, quejas o información acerca de ADA o la sección 504

pueden hacer al/la coordinador/a del distrito.

Section 504 and ADA: Programs & Services

Dr. Robert Brown

Chief Academic Officer / Deputy Superintendent

20200 Eastway Village Drive

Humble, Texas 77338

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281-641-8005

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Wisenbaker Practicum Course Syllabus2017-2018

Program Orientation 1 st 6 weeks

A. Discuss Wisenbaker Practicum Rotations Course Handbook

B. Obtain the necessary signed forms from students/parents

C. Complete the OSHA StartSafe/StaySafe

D. Investigate the origins of the Wisenbaker Company

E. Meet Wisenbaker directors, managers and supervisors

F. Tour property

UNIT I. Becoming a Great Employee in Today’s Work World 1 st 6 weeks

Students will begin their six week Practicum Rotations at the Main Building site October 2, 2017.

A. Employability Skills and Work Ethics

B. What Makes a Good Intern?

C. Interpersonal Communication and Emotional Intelligence

D. Developing a Positive Personal Brand

E. Harassment and the professional work enviroment

F. Blood Borne Pathogens

G. Rotation Journals and Electronic Portfolios

H. Daily Standups

I. Professional Book reviews

UNIT II. The Business 2 nd and 3 rd 6 weeks

Students will begin their second six week Practicum Rotations at the Main Building site

November 14, 2016.

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A. Business Structures – sole proprietor, partnership, corporation and franchise

B. Management - Chain of Command – Corporate Positions, management tasks and management skills

C. Human Resources Department-purpose and function

D. Marketing and Sales- the Marketing Plan and Promotion Methods

E. Accounting- functions and positions

F. Billing-Accounts payable and accounts receivable

UNIT III. Customer Service 4 th Six weeks

Students will begin their third six week Practicum Rotations Reeveston at the site January 17, 2017.

A. Customer Relations and Quality Service- customer needs and satisfaction; critical moments; customer relations techniques

B. Business Communications

Unit IV. Business Operations 4 th Six weeks

A. Purchasing

B. Operations

C. Inventory

D. Company Confidentiality

Unit V. Professional Development 5 th six weeks

A. Resume writing

B. The Job Application

C. The Interview

D. The Interview follow-up Thank You note

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Cover Sheet for Student Appraisal Form- 1

Director/Manager/Supervisor/Trainer:

Attached are the student’s 2 Week Evaluation Form and the Rotation Competencies Form. Please evaluate the student for their progress report in your department. Feel free to discuss the evaluation with the student and the Instructor.

Please return evaluation forms to Mrs. McCann by ____________________

Thank you so very much!

Risa McCann

Cover Sheet for Student Appraisal Form -2

Director/Manager/Supervisor/Trainer:

Attached are the student’s 2 Week Evaluation Form and the Rotation Competencies Form. Please re-evaluate the student for their final grade in your department. If there are no changes please just initial and date the new evaluation form. If the grade/evaluation has changed, either lower or higher, please complete the new evaluation form. Feel free to discuss the evaluation with the student and Mrs. McCann.

Please return evaluation forms to me by _____________________

Thank you so very much!

Risa McCann

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Student Performance Appraisal

Name: Grading Period:

Training Station:

JOB SKILLS GRADE (Circle One)

Excellent Needs Improvement

1. Overall work performance 5 4 3 2 1

(asks questions, appears interested)

2. Follows directions & completes

tasks as assigned 5 4 3 2 1

3. Follows safety rules & regulations 5 4 3 2 1

4. Accepts criticism & supervision 5 4 3 2 1

5. Displays initiative & motivation 5 4 3 2 1

6. Practices courtesy, proper 5 4 3 2 1

voice and language

7. Punctuality-arrival & departure 5 4 3 2 1

8. Appearance/grooming, uniform 5 4 3 2 1

9. Cooperation w/co-workers 5 4 3 2 1

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10. Accepts Responsibility 5 4 3 2 1

OVERALL SIX-WEEKS SCORE: 5 4 3 2 1

Comments

Please make suggestions for improvement of skills.

Which qualities are demonstrated as strengths?

Evaluator’s Signature

________________________________________

Date

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Student Participation Approval Letter

This handbook contains 2 copies of the Student Participation Approval Letter. One copy is to be kept by student and the second copy is to be returned to the course instructor as a part of the school records.

As a student enrolled in a training internship, you understand that:

1. The teacher will approve all training station placements.

2. Dismissal from a training station for insubordination, refusal to work, poor work habits or poor attitude, will result in a failing grade for that 9 week marking period.

3. If a student is terminated for dishonesty, theft, immoral conduct, or deviating from the Wisenbaker company policy, the student will be removed from the Wisenbaker Practicum Rotations I and II course immediately.

4. Students must notify the teacher by 7:00 AM if they are to be absent due to illness from school. Attendance will be verified with the student’s campus. Failure to notify teacher will result in lowered evaluation scores.

5. Students must wear the appropriate uniform each day and follow HISD and Wisenbaker Dress Code.

6. All Humble ISD School rules apply at the Wisenbaker sites.

7. All Humble ISD policies are applicable while students are attending program functions.

8. Students should display a professional attitude, loyalty and confidentiality (if necessary) towards the Wisenbaker Company.

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9. If problems persist in the classroom or at the training station, students can be removed from the program at mid-semester. Removal will be made after consultation with the student and their parents/guardians.

10. Enrollment is for one year and yields 3 elective credits.

11. Student must be a junior or senior on the first day of school.

12. Students are required to subscribe to REMIND. This is done by texting the message bd962f to 81010 and reminders will be sent out by the instructor using this service. Parents are also encouraged to sign up for REMIND by texting the message to the given phone number.

Parents and students, please read, sign and date below. Two copies of this agreement are included in this packet so that one can be kept by student in their binder and the other copy returned to the instructor.

I have discussed my son/daughter’s enrollment in the class and I approve of their choice. I have read and I understand the above information. In addition, I understand and agree that I am to communicate with the HISD teacher concerning problems at the training station, rather than talking directly with the company managers or supervisors.

________________________________ Student Date _____________

________________________________ Parent Date _____________

(Signature above and printed name below)

________________________________ Parent printed name

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Humble ISD Hospitality Program

Release of Liability

In consideration of the training and opportunities my child will receive by participating in the Humble ISD Wisenbaker Program, I, the undersigned parent or guardian, agree that I will be responsible for payment of all medical bills for treatment of injuries to my child, ______________________________________________, resulting from personal injuries sustained while my child is participating in the program; and for the consideration noted above, I hereby release and discharge the Wisenbaker Company and its employees from liability for any and all claims, suits and causes of action for any damages, personal injuries, property damage or wrongful death, even if caused in whole or in part by the negligence of the company or its employees, on account of injuries or death sustained by my child while participating in the program.

I understand that this AGREEMENT releases the company and its employees from liability as to any claim I could make for damages arising out of injury or death to my child while participating in the program.

__________________________________________

Student’s Name printed

_______________________________________________

Signature of Parent/Guardian

_______________________________

Date

___________________________ _____________________________

Work Phone Number Home Phone Number

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Humble ISD Medical Authorization

TO: Any physician, hospital, or other health care provider:

RE:_________________________________________________ (Name of Student)

We, the undersigned, represent and warrant that we are the parents or legal guardians of the above-named student, a minor child, and we do hereby give Risa McCann, of Humble ISD, the power to consent to any and all medical and/or health care which she deems necessary in an emergency while said child is in her custody and control while on a school sponsored trip or at a school sponsored learning site.

Signed this _________________________ day of _______________________________, 20_________ .

____________________________________ ______________________________

Print Name of Parent or Guardian Signature of Parent or Guardian

SUBSCRIBED AND SWORN TO BEFORE ME by ____________________________________

and _________________________________________ on this day of _______________________ , 20__ , to certify which witness my hand and seal of office.

Notary Public, State of Texas:_____________________________________________

My commission expires: __________________________________________________

ADDITIONAL INFORMATION:

Home Phone: _______________________ Business Phone: ______________________

Medical Insurance Company: ___________________________________

Insurance Co. Phone: __________________________________________

Policy Number: _______________________________________________

Medical Allergies: _____________________________________________

Pertinent Medical Information (diabetes, asthma, heart disease, etc.):

Medications: _________________________________________________

Family Doctor: ___________________________________ Phone: ________________

Other Contact in Emergency: ___________________________ Phone: ____________

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Student Dress Code Policy Agreement

I, ______________________________________________ , agree to follow the Wisenbaker Practicum Rotations (W.P.R.) “Standards of Professional Appearance,” which includes standards of hygiene, grooming and dress. In addition, I agree to also follow the Student Dress Code, as addressed in the Humble ISD Student Handbook.

I understand that the first infraction of the “Standards of Professional Appearance” will result in a private consultation with the instructor. I will sign an agreement to make the necessary changes immediately. Any future unacceptable grooming or dress code violations will result in disciplinary action and I may be removed from my training station until corrected.

I will bath and shampoo daily. I will use deodorant/antiperspirant daily. I will brush my teeth and ensure myself of fresh breath daily. I will shave all facial hair. I will launder my professional clothing daily. ___________ student initials

Student signature _________________________ Date _______________

HISD Instructor signature _______________________________

1st Infraction Date of Consultation ________________

Student signature ________________________________________

Parent signature _________________________________________

2nd Infraction

1st Infraction Date of Consultation ________________

Student signature ________________________________________

Parent signature _________________________________________

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Non-negotiables

Wisenbaker is engaged in a business where the total success is determined by the customer. Your attitude, appearance and work performance is the most lasting impression the company will remember. You, the student, must constantly be aware that in dealing with the Wisenbaker employees and customers you are creating an impression. Make the most of the opportunity! Rude, discourteous, or any conduct less than professional will not be tolerated by Wisenbaker, Mrs. McCann or Humble ISD. Any un-professional behavior will be sufficient cause for disciplinary action up to and including termination from the Wisenbaker Practicum Rotation program.

Expected personal conduct includes:

1. Be courteous – always treat other as you would expect to be treated, smile!2. Be Enthusiastic – a positive attitude spells Success!3. Be Neat- both in appearance and work4. Be Well-groomed - extreme clothing, jewelry, hair styles, fragrance and makeup are not

appropriate in business5. Be Cooperative - you are not just the student of a certain department, but a

representative of Wisenbaker, Mrs. McCann and Humble ISD and you should assume the responsibility.

Immediate Termination may result from the following incidents:

1. Theft2. Refusal to do an assigned task3. Use of profanity4. Fighting-physically or verbally5. Being out of designated area6. Leaving the job site without permission7. Use of cell phone while on W.B.S. property

______________________________ _______________

Student Signature Date

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Training Plan Agreement Unpaid Work-Based Instruction Student _______________________________________________ Grade ________ Age ____________

School District ___Humble I.S.D. __ Campus Name: Career & Technology Education Ctr.

Training Objective ________________________ Business Name _Wisenbaker Builder Services ____

Career Cluster __Business and Industry __ CTE Course Title_ Wisenbaker Practicum Rotations_

Time Class Meets ___11:05 – 2:45 PM ______ PEIMS Code __12701200____

The student agrees to diligently perform the work-based training experiences and conscientiously pursue the coordinated classroom course of study as outlined in this training plan. Work-based training experiences will be assigned by the training sponsor and performed according to the same company policies and regulations applicable to regular employees. The student agrees to take advantage of every opportunity to improve his or her efficiency, knowledge, and personal traits in order to pursue further education and enter the chosen occupation as a desirable employee. The company and school are responsible for providing the student with opportunities for training in the basic skills of an occupation and knowledge of related technical information. In order to provide a systematic plan for well-rounded training, a schedule of work-based training experiences and a parallel classroom course of study have been coordinated and agreed upon by the training sponsor and CTE teacher. It is understood that the work-based training experiences will be unpaid. In order to qualify for an exemption from wage requirements, all six of the following criteria must be met: 1) training, even though it includes actual operation of the facilities of the employer, is similar to that which would be given in a career and technical education program; 2) training is for the benefit of the student 3) the student does not displace regular employees but works under their close supervision; 4) the training sponsor derives no immediate advantages from the activities of the student and on occasion operations may actually be impeded; 5 ) the student is not necessarily entitled to a job at the conclusion of the training period; and 6) the training sponsor and the student understand that the student is not entitled to wages for the time spent in training. The training period begins the _2_ day of October , 2017, and extends through May 28, 2018____. There will be a probationary period of _XXX___ days during which the interested parties may determine if the student has made a wise choice of an occupational training area, and if the training should be continued. This plan may be terminated for just cause by either party without recourse. Is the training objective listed considered to be a hazardous occupation by the U. S. Department of Labor, Employment Standards Administration and the Wage and Hour Division: Yes ____ No _XXX__ If yes, any exemption(s) for student-learners or apprentices will apply as described in the Youth Employment Provisions for Nonagricultural Occupations Under the Fair Labor Standards Act - Child Labor Bulletin 101 or Child Labor Requirements in Agricultural Occupations - Child Labor Bulletin 102. Current information for exemptions is available from the U. S. Department of Labor in the Wage and Hour Division or its website at http://www.dol.gov/whd. It is the policy of School District not to discriminate on the basis of race, color, national origin, sex or disability in its Career and Technical Education programs, services or activities as required by Title VI of the Civil Rights Act of 1964, as amended; Title IX of the Education Amendments of 1972; and Section 504 of the Rehabilitation Act of 1973, as amended. Es norma de Distrito Escolar no discriminar por base de raza, color, origen nacional, sexo o impedimento, en sus programas de Educación y Carreras Técnicas servicios o actividades vocacionales, tal como lo requiere el Título VI de la enmienda de la Ley de Derechos Civiles de 1964, el Título IX de las enmiendas de Educación, de 1972, y las enmiendas de la Sección 504 del Acta de Rehabilitación de 1973. Signature Approvals __________________________________________ ____________________________________________ (Student) Date (Training Sponsor) Date __________________________________________ ____________________________________________ (Parent or Guardian) Date (CTE Teacher) Date Note: Each party to this agreement should receive a signed copy. Keep the original or a copy with the student’s permanent record.

Revised: 1/2015

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Training Plan Agreement Unpaid Work-Based Instruction

Student ______________________________________________Grade ________ Age _____________