form 1 Utah State University Cooperative Education Internship Agreement
Student Name ____________________________ Major _____________________ A# ____________________ On-Campus E-mail: ________________________________ Office E-mail ______________________________ Street Address ________________________________ City ________________ State _____ Zip ____________ Telephone: Home ______________________ Work ____________________ Course Number ______________ Faculty Co-op Coordinator Name _________________________________ Campus Phone _________________ Company/Business ___________________________ Immediate Supervisor’s Name ______________________ Work Address ________________________________ City _________________ State _____ Zip ____________ Rate of Pay _______________ Hours worked weekly __________ Supervisor’s Work Phone ________________ Semester Enrolled:
Fall Spring Summer Tuesday Year ____________
Work Schedule: _______________ _______________ _______________ _______________ _______________ Monday
Wednesday Thursday Statement of Student’s Learning Objectives
You will be required to establish five learning objectives for the specified grading period. The learning objectives must be originated by you, the student, approved by the employer/supervisor, and reviewed by the department faculty co-op coordinator for validity and relative value with all parties in agreement.
ATTACH A COPY OF YOUR 5 LEARNING OBJECTIVES TO THIS FORM
We, the undersigned, agree with the validity of the learning objectives listed above (or attached). The employer and the college agree to provide the necessary supervision and counseling to insure that the maximum educational benefit may be achieved from the student work experience. The student agrees to abide by the cooperative education guidelines as outlined in the Student Manual. The supervisor will evaluate the student’s learning objectives and work performance at the end of the grading period. The university will award academic credit for successful accomplishment of the objectives in the cooperative education student manual.
____________________________ ____________________________ ____________________________ Student
date Work Supervisor date Faculty Coordinator Friday
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