Fillable InstructorConsultationRecordForm - Instructor's Consultation Record

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InstructorConsultationRecordForm - Instructor's Consultation Record

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Los Medanos College FA/SP/SU ______
(Circle one) (year)
Cooperative Work Experience Program
Instructor’s Record of Employer and Student Consultations
The following record of employer and student consultations is to be signed and submitted for inclusion in the
student’s folder at the close of the semester. The Cooperative Work Experience Program requires instructors
to make a minimum of one on-site visit with each participating employer during the course of the semester. It
also requires a minimum of two personal meetings with each participating student.
Student ___________________________ CWEE Instructor ______________________________
Employer ___________________________ Worksite Supervisor ______________________________
EMPLOYER VISITATIONS
MEETINGS WITH STUDENT
- 1
ST
Visit - Date: _________________________ - 1
st
Meeting - Date: _______________________
Location of Meeting: ________________________ Location of Meeting: ________________________
Purpose: _________________________________ Purpose: _________________________________
_________________________________________ _________________________________________
Outcomes/Comments: _______________________ Outcome/Comments: ________________________
_________________________________________ _________________________________________
_________________________________________ _________________________________________
- 2
nd
Visit - (Optional): _______________________ - 2
nd
Meeting - Date: ______________________
Location of Meeting: ________________________ Location of Meeting: ________________________
Purpose: _________________________________ Purpose: _________________________________
_________________________________________ _________________________________________
Outcome/Comments: ________________________ Outcome/Comments: ________________________
_________________________________________ _________________________________________
_________________________________________ _________________________________________
CWEE Instructor’s Signature: ______________________________ Date: _____________________
Comments: _______________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
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InstructorConsultationRecordForm - Instructor's Consultation Record

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Completed 18 February 2020

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