Applied Science Co-operative Education
2
385 East Mall
Vancouver, BC Canada V6T 1Z4
phone: 604 822 3022
email: apsc.coop@ubc.ca
www.coop.apsc.ubc.ca
Co-op Work Term Technical Assignment Release Form
Student Instructions
Please fill out the form and have your supervisor indicate whether or not the assignment is confidential and sign the bottom of the
form. If your report is not confidential, submit the signed release form and your assignment to Canvas for grading by the assignment
deadline indicated in the work term checklist. If your report is confidential, provide your supervisor with the confidential grade form
found on the work term checklist and request that they grade your assignment. Submit both the signed release and confidential
grade forms to Canvas by the assignment deadline indicated in the work term checklist.
Student Name: _____________________________________ Date: _______________________________
Student Number: _____________________________________
Discipline:
_______________________________
Work Term Period: Year: _________________
Jan – Apr
May – Aug
Sept Dec
Company Name: _________________________________________________________________________________
Supervisor Name: _________________________________________________________________________________
Title of Assignment: _________________________________________________________________________________
Supervisor Instructions
Please indicate which statement applies to the student’s technical work term assignment by checking the appropriate box then sign
the bottom of the form. If the report is confidential, we kindly ask that you grade the report using the confidential grade form
supplied by the student. Please return this signed release form and the confidential grade form (if applicable) to the student. It is the
student’s responsibility to submit the form(s) to the co-op program.
The assignment is not confidential and can be submitted to the engineering co-op program for grading.
The assignment is confidential and will be retained by our company. I will grade the report using the grade form
supplied by the student.
Supervisor Name:
______________________________________
Phone Number:
___________________________
Supervisor Signature:
______________________________________
Date:
___________________________
click to sign
signature
click to edit