Program Application

Complete the application below to get started with the Cooperative Work Experience (CWE) program. All information is confidential. If you prefer, you may download the application, complete it by hand and bring it to the CWE Office.

* Required fields. Please complete all required fields.
Program Application
 
Personal Information
* Name:
Last name First name Middle Initial
* Student ID:
* Home Address:   Street Address
* City:
* State: * Zip:
* Home Phone:
Cell Phone:
* e-Mail:
* Group Reference:
 
* College Major or Career Goal
 
 
Employment Information
* Employer:    
* Work Phone:    
* Work Address:
* City:    
* State: * Zip:  
* Supervisor:
* Supervisor's Phone:    
* Job Title:
* Work Schedule
Mon
Tue
Wed
Thur
Fri
Sat
Sun
examples: 9-4 or 10:30 -2:30, etc.
* Total Hours to be worked:    
 
* Previously Enrolled in Co-op Program?      Yes      No
 
The objectives of the Cooperative Work Experience Program are for you to:
  • Learn on your job.
  • Improve your job performance.
  • Accept new responsibilities and handle them successfully.

STUDENT AGREEMENT:
To receive credit for your participation in this course, you must agree to and meet the following commitments to your employer and to the Cooperative Work Experience Program.

I agree to:

  • Work to achieve the Cooperative Work Experience (CWE) learning objectives that my supervisor, instructor, and I agree upon.
  • Be prompt in my job attendance, be appropriately groomed, honest, courteous, and willing to learn under supervision.
  • Work 50 hours per quarter for each unit of credit in paid employment, or work 40 hours per quarter for each unit of credit in an unpaid community-based learning position (unpaid positions must comply with all labor law requirements).
  • If I am released from employment, I understand that I need to notify my instructor as well as the CWE office and DROP the course immediately.
  • Complete and submit all required documents, written reports, and Cooperative Work Experience Program timecards of my hours worked to the CWE office by the required deadlines.
  • Call, e-mail or visit my instructor as required by the program, and comply with all reasonable requests.
  • Notify my instructor or the CWE office of any changes in my academic or work schedule.

I have read all statements and I accept and agree to fulfill these obligations to earn credit for participating in the Cooperative Education Work Experience Program. I understand that my employer and my instructor will evaluate my work before I am allowed to receive credit for participation. I further understand that I will be subjected to the current grading policies of Foothill-De Anza College District as well as the policies of the Cooperative Work Experience Program.

* Electronic Signature (Type your first and last name.):

For information regarding FHDA District's policies and procedures regarding anti-discrimination and harassment, please refer to the Foothill/De Anza website at http://www.fhda.edu; the Foothill College Catalog, the Foothill College Class Schedule; or the Dean of Student Activities at (650) 949-7241.

You and your Instructor will sign this agreement in person when you meet.
Form Validation -

Please complete this Form Validation field before submitting the form.If you can't read the sample words, use the Refresh button refresh button to get a new set of words. Or use the Audio Clue button audio button to listen to a phrase.
Upon submission, the request will be sent to the COOP office. Thank you!
Cooperative Work Experience
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