Co-Op Education Program Interest Form

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Please complete this Co-Op Education Program Interest Form to be considered for available opportunities.

General Information

First Name *

Middle

Last Name *

University you are currently enrolled in? *

Bronco ID

For Cal Poly Pomona students ONLY!

Major *

Academic Level (select one) *

To participate in the program, you must either be a current sophomore, junior, or early senior standing to be eligible to apply.

Sophomore

Junior

Early Senior (must be senior level in the 1st quarter/semester of the current year)

Expected Graduation *

Month and Year

Month

Day

Year

Address *

Please use your current mailing address.

Country *

Address 1 *

Address 2

City *

State *

ZIP code *

Primary phone number *

Primary phone number, part 1

Primary phone number, part 2

Primary phone number, part 3

Primary email address *

Employment Information

Have you been previously employed by the Cal Poly Pomona Foundation? *

Yes

If you are a Cal Poly Pomona student, are you currently employed on campus? *

Yes

If yes, what Department/College are you working for:

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. If I am selected for the Co-Op Education Program, I understand that any false or misleading information could result in termination.

If I am hired for a Co-Op Education Program position, I must maintain at least a 2.5 GPA and enroll in a Co-Op/Internship course designated by my academic advisor for the duration of my internship. If a course is not available through my university, enrollment through Cal Poly Pomona’s Office of the Extended University will be a requirement. Summer enrollment is not required.

Non-Cal Poly Pomona students must submit to the Co-Op Education Program's department proof of enrollment every quarter/semester until their internship ends.

Signature of participant *

Clear signature

Date *

Month

Day

Year