Cooperative Education Student Application - McCarthy

1.

Please select the semester you are applying for: ✱

Spring

Summer

Fall

2.

Your Personal Contact Information:

First name ✱
Last name ✱
Email ✱	Email is already used by another user
Home Phone (Please use dashes between numbers: ie: 123-456-7890)
Cell Phone (Please use dashes between numbers: ie: 123-456-7890) ✱
G Number ✱
Gender ✱

3.

Employment Information: ✱

Company Name	An answer is requiredCompany Name
Type of Work	An answer is requiredType of Work
Street Address	An answer is requiredStreet Address
City, State, Zip Code	An answer is requiredCity, State, Zip Code
Name of Immediate Supervisor	An answer is requiredName of Immediate Supervisor
Supervisor Phone (Please use dashes between numbers: ie: 123-456-7890)	An answer is required Supervisor Phone (Please use dashes between numbers: ie: 123-456-7890)

4.

Are you in an internship? ✱

Yes

No

5.

If you are in an internship, do you get paid for your work?

Yes

No

I am not in an internship position

6.

Are you a veteran? ✱

Yes

No

7.

List Number of Units You Have Completed: ✱

Coop Units Enrolled In	An answer is requiredCoop Units Enrolled In
College Units (do not include Coop Ed units)	An answer is requiredCollege Units (do not include Coop Ed units)
Total Units Currently Enrolled In	An answer is requiredTotal Units Currently Enrolled In

8.

What are your Current Major and Career Goal?

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