CAREER SERVICES & COOPERATIVE EDUCATION REGISTRATION
Please complete and submit this form for personalized assistance. All information you provide is
voluntary and completely confidential.
LAST NAME: FIRST NAME:
ADDRESS: CITY: STATE: ZIP:
ID#: BIRTHDATE:
E-MAIL: PHONE:
I WOULD LIKE MORE INFORMATION ABOUT:
Career Advising: choosing a major/career; matching jobs with majors
Cooperative Education/Internship
Job Search: PT/FT jobs
Résumé Writing, Interviewing
Credential Files
Other: __________________________________________________
I AM CURRENTLY ATTENDING MSU-BILLINGS:
Yes If Yes: Part-Time Full-Time
No
COLLEGE CLASS: ANTICIPATED GRADUATION DATE:
Freshman 200_______________________
Sophomore Current GPA _______________
Junior
Senior MAJOR: __________________
Graduate MINOR: __________________
I LEARNED ABOUT THE PROGRAM FROM:
MSU-Billings Advisor Brochure/Publication Internet
MSU-Billings Faculty/Staff Community Agency Career Fair
Class Presentation Friend/Self Referral Other
What other information would help us better serve you?
________________________________________________________________________
________________________________________________________________________
I authorize Career Services to retain this information with copies of other documents which are
part of the career counseling and internship process.
___________________________ ________________________
Signature Date
Rev 4/03 Y:\ADMIN\Forms & Templates\Web CLIENT INFO 2003.doc
Instructions for Completing Form Online
Click Here to Print. Then, sign and send.