Free agency agreement 33
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School-to-Work Program
Student/Agency Agreement Form
I, ____________________________, have selected ______________________________
(Print Student’s Name)

(Employment Agency Name)

as my Employment Agency (Agency) for the School-to-Work program (S2W) and we will begin
working together on this date: __________________________.
(Date Required)

By choosing this agency, and signing this form, I am requesting that King County Developmental
Disabilities Division (KCDDD) pay this Agency for supported employment services through S2W,
effective on the date written above.
My S2W team consists of my:
Teacher, ___________________________, at _______________________ School District
Parent/Provider, _____________________________
Employment Consultant (if determined), ________________________
Developmental Disabilities Case Manager (if applicable), _____________________________
I understand the following about what it means to participate in S2W:

The Agency will work with my S2W team to