Student Info

STUDENT INFORMATION

INSTRUCTIONS (read once, read twice, then proceed):

Students are able to complete the CoOp Ed Student Information sheet and upload over the internet on this page. This is a two part process. Complete PART's ONE, & TWO listed below. Follow these instructions EXACTLY to insure that get the highest points possible. Remember this is worth 20 points of your grade.

Video Explanation of this Assignment. Press Play to view

PART ONE:

1. You have received a Student Information sheet sample in the class syllabus distributed in class. You may complete that sample as a guide to assist you in filing forms. However, this sample sheet will not be accepted for points. When you fill out the sample Student Information sheet, you MUST be COMPLETE and accurate.

2. You MUST Down Load the Student Information sheet from this web site. Save it to a disk on your system. Then complete the Student Information sheet on your word processing. This will be typed.

3. PRINT THREE copies of your completed Student Information sheet from the Down Load. Submit TWO completed forms to your Cooperative Education instructor in class (bring to class).

PART TWO:

1. Complete the Electronic Student Information sheet below. USE the Printed Student Information sheet you have made as your guide. Remember that you MUST BE COMPLETE and ACCURATE.

ELECTRONIC STUDENT INFORMATION

Date: MM/DD/YY

STUDENT INFORMATION

Last Name First Name MI

Gender:

Current Semester Term

School ID (begins with 88) - -

Birth Date: MM/DD/YY Age

Home Address:

Street Apt./Suite

City State CA Zip-

e-mail

Home Phone () - Work Phone () - ext:

EMPLOYER INFORMATION

Company Name

Supervisor:

Last Name First Name Title

Phone # ()- Fax # () -

Supervisors e-mail

Work Address:

Street Bldg/Unit #

City State CA Zip-

Where do we park when we visit?

Does your company validate Parking Y/N?

Nearest major cross Streets

What product or service does your company sell or provide?

Describe your duties:

Work Experience:

Paid/Unpaid

Salary/Wage per

How many hours per week do you work

What is your Major

CoOp Ed Section #

Current CoOp Ed Units

Which semester are you in CoOp Ed?

How many CoOp Ed units have you already completed in LACCD?

Current Units enrolled in School?

(Pierce, High School, 1,2,3,4,5---22)

Name of School/College/University

Are you also currently attending High School?

SES DATA

Highest grade in school completed

Degrees earned

Ethnicity

Are you enrolled in any specially funded programs? (please check all that apply)

Special Services (Handicapped assistance)

Limited English or ESL

EOPS

GAIN

Work Study

Day Care Services

Single Parent & Homemakers Program

Veteran's subsistence

Other not listed

Pace Program Participant

U.S. Veteran? Y/N

U.S. Citizen? Y/N

Note: The information provided on this form is confidential and will not be released to any persons other than authorized College Personnel.

Then press the Submit button to send your information to our data bank.