School of Engineering
Department of Electrical and Computer Engineering

14:332:496/497 CO-OP INTERNSHIP

APPLICATION FORM



*This form MUST be completed before registering for Co-op.  It must be approved by the Undergraduate Director (CoRE 525).

I. PERSONAL INFORMATION 

Student's Name (Print): __________________________________________________________

                                 (Last)          (First) 

Phone:  ________________________   Class of: ______________________

Email: _________________________   Course: 14:332:496____ or 14:332:497____  
 

Start Date: ___________ End Date: _____________  
 

II. EMPLOYER INFORMATION 

Employing Institution: ___________________________________________________________

Supervisor/Contact Name(s): 

1. __________________________________ Phone/Fax: _______________________________ 

 Email: ____________________________________ 

2. __________________________________ Phone/Fax: _______________________________ 

 Email: ____________________________________ 

Job Description: 
 

III. Regulations:

  1. Co-op credits count ONLY towards technical electives
  2. Graded on a Pass/No Credit scale
  3. Final report (1-2 pages) MUST be submitted at end of Co-op summarizing work
  4. Supervisor(s) MUST submit evaluation at the end of the Co-op
  5. Only TWO courses may be taken while on Co-op.  Only ONE course during the day.
  6. MUST work continuously for 6 months (Semester+Summer)
  7. Full-time job assignment required
 

IV. Signatures:

      I have read the above regulations and understand the rules for my co-op assignment 

Student's Signature: ____________________________________ Date: ___________________    


Faculty Advisor's Name and Signature: _______________________________ Date: ___________________   

Undergraduate Director Signature: _______________________________ Date: ___________________   



Index Number: ___________     Special Permission Number: ____________


Title of the project: ________________________________________________________