Fillable CWEEApplication Form Email Template

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CWEEApplication Form Email Template

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The CWEEApplication Form Email Template form is 1 page long and contains:

  • 1 signature
  • 8 check-boxes
  • 28 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Los Medanos College

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COOPERATIVE WORK EXPERIENCE EDUCATION
APPLICATION AND AGREEMENT FORM
Semester: Fall Spring Summer Year:________ Request Instructor: (optional)_________________________
ENROLLMENT: Complete this application and return to LMC Employment Center for approval. When you have completed mandatory orientation you will receive a
Course Section number and permission to enroll at the Admissions Center, by phone or on WebAdvisor. Check the LMC Employment Center
webpage for the mandatory Orientation schedule.
Deadline for enrollment is the last day to register for the semester/session.
How many times have you taken COOP?__________________ How many units are you taking now?____________
Name (print)
Last Name First Name
Student ID#
Address
City State Zip Code
Phone # Email
College major or Career goal
List the hours that you are available to meet with your COOP instructor (hours not in school or work):
Monday Tuesday Wednesday Thursday Friday
Company/Organization Name
Address
Numbers of hours you work per week:________________________________________ Date you started working______________
Your job title and duties: _____________________________________________________________________________________
Supervisor’s Name
Phone # Email
Best time to call supervisor:
Paid Job
Non-Paid Job
Please check the appropriate course for which you are applying:
COOP-160 – Job does NOT relate to major/career goal
*COOP-170 – Job RELATES to major/career goal
*COOP-170A – Job RELATES to major/career goal AND student has Department approval
DISIPLINE________________________________________________________ UNITS:___________________________
* All COOP-170 and COOP-170A courses are located in individual disciplines, i.e.: ADJUS-170, CHDEV-170A, RNURS-170, etc.
I agree to abide by the Cooperative Work Experience Education guidelines and understand that failure to abide by the guidelines
and/or unsatisfactory completion will result in a lower or failing grade. I MUST add & pay through Admissions & Records in order for
the application to be processed.
______________________________________________________________ ____________________________
Student’s Signature'DWH
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CWEEApplication Form Email Template

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Completed 18 February 2020

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