Form Apsc 410 - Technical Memo Release
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1Engineering Co-op Program
Faculty of Applied Science
2385 East Mall
Vancouver, BC Canada V6T 1Z4
Phone 604 822 3022
Fax 604 822 3449
eng.coop@ubc.ca
Technical Memo Release Form
(APSC 410)
STUDENT (Please complete this section):
Last Name:
First Name:
___________________________
_____________________________
Discipline:
Chemical and Biological Engineering
Mechanical Engineering
Civil Engineering
Materials Engineering
Computer Engineering
Mining Engineering
Electrical Engineering
UBCO – Civil Engineering
Environmental Engineering
UBCO – Electrical Engineering
Geological Engineering
UBCO – Mechanical Engineering
Integrated Engineering
Master of Engineering_______(disc)
Work Term Period:
Year ___________
Jan. – Apr. May – Aug.
Sept. – Dec.
EMPLOYER (Please complete this section):
Company Name (Please print):
_______________________________________________________________
Department:
_______________________________________________________________
Supervisor’s Name:
____________________________ Title: _____________________________
Supervisor’s Telephone Number: ____________________________ Fax: _____________________________
Title of Memo:
____________________________________________________________________________
I have received the Work Term Assignment.
The Memo is Confidential and will be retained by our company.
Note to employer: Evaluation of Confidential Memo form is due two weeks after the
student’s Work Term Package deadline.
The Memo is not Confidential and may be submitted to the Engineering Co-op Office
for marking at UBC.
I have not received the Work Term Assignment.
_____________________________________________________________
Reason:
Supervisor’s Signature: _________________________________ Date: ____________________________
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