Co-op Start Date (mm/dd/yyyy)
Your Personal Information:
Status in Major
Your Co-op Supervisor's Name
Your Co-op Supervisor's Phone
Co-op Supervisor's Email
Your Hourly Rate of Pay:
Number of hours you work per week:
Number of Previous Co-ops with same employer:
Number of Previous Co-ops:
Co-op Course(s) Taken
Have you completed a Co-op application?
Have you reviewed your Co-op Learning Objectives with your Faculty Mentor for ESC 300/400?
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