Co-op Placements

First Name

Last Name

Email Address

Co-op Term

Employer Name

Employer Location

Supervisor Name

Supervisor Email Address

Supervisor Phone Number

Please indicate if the co-op will be remote, in person, hybrid, or unknown Please indicate if the co-op will be remote, in person, hybrid, or unknownRemoteIn PersonHybridUnknown

Does this co-op meet the 15-week requirement? Does this co-op meet the 15-week requirement? YesNoUncertain

Start Date

End Date

Will you be receiving direct pay from the employer for this position? Will you be receiving direct pay from the employer for this position? YesNoUnsure

Will you be receiving any funding for this position that you know of aside from direct pay from the employer (e.g. a fellowship, work study, etc.)? Will you be receiving any funding for this position that you know of aside from direct pay from the employer (e.g. a fellowship, work study, etc.)? YesNoUnsure

Will you need CPT work authorization (for F-1 international students)? Will you need CPT work authorization (for F-1 international students)?YesNo

Notes (optional):