COOPERATIVE EDUCATION REGISTRATION ~ COLLEGE OF TECHNOLOGY

STUDENT INFORMATION:

Last Name   First Name   PID #    E-mail

Present Address:  

City   State Zip  

Phone   Mobile

Student Address During Co-op:  

  City State Zip  

Country Phone Mobile

Age   Gender   Ethnicity  If other:

Technology Major Academic Advisor    

CO-OP EMPLOYER INFORMATION:

Employer  Contact Last Name   Contact First Name 

Address   City   State  Zip Code  

CountryPhone   Fax Employer Email Website 

Job Title of co-op position Level applying for: Semester: Year:   

Job Description 

Number of work weeks:       Number of hours worked per week:       Part-Time Full-Time:

Describe your weekly work schedule: (Ex.: M- F, 40 hours/week, 8:00 a.m.-5:00 p.m.)  

Start Date   End Date   Hourly rate of pay ** $   Total wages earned during co-op $  

** If co-op is unpaid, you must submit a wage waiver form by email to coop@bgnet.bgsu.edu.  Click here for wage waiver form.

If pre-registered for classes, list classes to be dropped:

How did you secure the proposed co-op position? If other:

Previous Co-op History (as applicable):                                                                                                                                                                                 

TECH 289:

Semester

 Year: 

 

Employer City

Supervisor

Univ Rep

TECH 389: 

 Does the immediate supervisor have more expertise in your technology than you do? If no, explain:   

Will you receive supervision on at least a daily basis?  If no, explain:   

Does your prospective co-op employer understand you are to receive academic credit for your work? If no, explain: 

How will your responsibilities increase in relationship to any previous co-op(s)?

Are you an associate degree holder? If yes, name of institution:

Was any co-op done on a credit-by-examination (CBE) basis and/or still pending? If yes, which co-op level(s)?

By typing my name below, I acknowledge that I have completed the co-op workshop, obtained and understood the Cooperative Education Policy & Procedure Statement, posted my resume in my Place Pro account and understand the report requirements. I also understand and acknowledge all relevant deadlines, site visits, grading policy and fee structure.  

Student Signature   Signature Date  

    Print form before submitting



Copyright © 2004 BGSU. All rights reserved.
Revised: March 08, 2007