12 Form Originating Office: Vice President of Academic Affairs Revised April 20, 2016
Appendix B
Bay College
Co-op/Internship Application/Registration Form
The following student has requested and applied for a Co-op/Internship position. Course Number:_________
Student Name: ___________________________________________________ Student ID#: ______________
Address:__________________________________ City: ___________________ State: ____ Zip: _________
Phone #: ____________________ Birth Date: _______________Social Security #: ______________________
Program Area: ______________________________________________________________________________
Registering for: (Circle one) 1. Co-op 2. Internship Number of Credit/Contact Hours: ______
Employer Site: ______________________________________ Supervisor’s Name: ______________________
NAME
_______________________________________________ Phone #:_______________________
ADDRESS
I am registering for: (Circle One) Fall Winter Summer 1 Summer 2 Year:__________
Total Academic Program Credits Earned: ___________________________ GPA: ______________________
Co-op/Internship students give permission to allow Bay College to furnish copies of transcripts to employers upon
request. A student work résumé and copy of Bay College transcripts must accompany this application.
I certify that the information contained on this application is correct and that I have read and agree to comply with
the procedures and directives listed in the Bay College Co-op Education and Internship Handbook.
______________________________________ ___________________
Student Signature Date
______________________________________ ___________________
Faculty Contact Date
______________________________________ ___________________
Academic Dean Date
FOR STUDENT RECORDS ONLY:
_____________________________________________ _______________________
Registrar’s Authorized Signature Date
Student has been registered and tuition charged to his/her account.
Note: Please return a copy to the Academic Dean and Career Advisor.
The student must work a minimum of 40 clock hours for every one (1) credit hour of co-
op/internship work experience (maximum of 8 credits). Tuition is based on a ratio of 1 contact
hour for each 1 credit hour of co-op/internship work experience. The co-op/internship applicant
must remain a student at Bay College throughout the duration of the program and must have an
approved training plan prior to the start of the work experience.
Instructor Checklist of items to
be returned to Admin Asst.:
____ App/Registration Form
____ Student Transcript
____ Student Résumé
____ Training Plan
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