Cpt Handout And Co-Op Agreement Page 3
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4C O-OP AGREEMENT FORM
PAG E 1
Please deliver a copy of your unofficial transcipt along with this agreement form to the Office of Career Services.
STUDENT INFORMATION
Co-op Term:
Fall
Spring
Summer
Year: 20
Student Status:
Soph/Junior (Undergrad.)
Senior (Undergrad.)
PLEASE SELECT ONE
Masters’
Ph.D
UNM Student I.D.:
College:
Concentration:
First Name:
Middle Int.:
Graduation Date:
Current GPA:
Last Name:
Sex:
F
M
Month
Year
Phone #: (
)
Work Status:
U.S. Citizen
Perm. U.S. Resident
Email:
F-1 Student Visa
Other:
EMPLOYER INFORMATION
Supervisor:
Company:
Address:
Title/Position:
City:
State:
Zip:
Phone #: (
)
Email:
Industry Sector:
Government
Non-Profit
Manufacturing
Service
Education
Research and Development
Other:
POSITION INFORMATION
Position Title:
Work Hours:
(per week)
(semester total)
Start Date:
Wage: $
.
Monthly
Hourly
Stipend
(beginning of semester)
Month
Day
Year
Is this your first Co-op position?
Yes
No
End Date:
(end of semester)
Month
Day
Year
Is this a continuation of a previous Co-op position?
Yes
No
POSITION DUTIES & RESPONSIBILITIES
(Highlight tasks and work activities or attach offer letter from the employer to this form.)
LEARNING OBJECTIVES
(Explain how duties and responsibilities directly relate to courses and UNM major/concentration. Specify at least three objectives.)
The University of New Mexico • MSC06 3710 • 1 University of New Mexico • Albuquerque, NM 87131-0001 • Phone 505.277.2531 • Fax 505.277.9285
Student Services Center, Rm. 220 •
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