Indicate Current Catholic School Board:
Other. Please specify:
Classes will be filled on a first-come, first-served basis. Please FAX completed and signed registration to the Centre for Lifelong Learning at 519-659-
2282. The fax date will be the Centre’s method of determination of registration priority and class assignment.
Contact Email (Parent): __________________________________________________________________________
(Confirmation of on-site and on-line course registration will be sent to this email address)
Student Email Student Cell #
Gender: ______________
SURNAME GIVEN NAMES 9 DIGIT OEN (Ontario Education Number) BIRTH DATE
(Month/Day/Year)
Your PRESENT GRADE (2014-2015)
HOME ADDRESS
PRESENT SCHOOL ATTENDING (2014-2015) SCHOOL ATTENDING IN SEPTEMBER 2015
CITY PROVINCE POSTAL CODE
INFORMATION BELOW IS FOR (CHECK) _____ MOTHER _____ FATHER _____ GUARDIAN
HOME TELEPHONE NUMBER
SURNAME
ADDRESS IF DIFFERENT THAN STUDENT’S CITY
CO-OPERATIVE EDUCATION PLACEMENT REQUEST
Placement Preference: 1 st Choice:
Suggested related course successfully completed 1.
GIVEN NAME
PROVINCE POSTAL CODE
2 nd Choice:
2.
DAYTIME TELEPHONE NUMBER
Reason for applying for SHSM Co-op:
CO-OPERATIVE EDUCATION EMPLOYEE INFORMATION (If available)
Name of Placement
Address:
Work Number:
I have made contact with the employer
ADDITIONAL INFORMATION
In-School Course Code:
Trade Area of Specialization:
 Yes  No
Employer’s Name:
City:
Cell Number:
Summer School Co-op Course Code:
EMERGENCY CONTACT NUMBER
Will this course make you eligible for an OSSD this summer?
Have you previously taken Co-op credits?

Yes

No

Yes

No Employer’s Name:
Attendance (Current Semester) Number of Absences: Number of Lates:
Regular attendance as arranged between the training organization (co-op employer) and the Co-op Teacher is required. A medical certificate must be available after a student has been absent for a TOTAL OF 3 days for any reason. Families must ensure that holidays and other activities do not jeopardize a student’s enrolment status in the summer co-op program.
We have read and understand that regular attendance and punctuality are mandatory.
SIGNATURES
STUDENT PARENT
GUIDANCE COUNSELLOR DATE

Pick up the Summer School Co-operative Education Package from the Guidance Department.
 Please give your completed and signed registration form to your Guidance Counsellor who will check it, sign it and fax it to the CFLL.
 The Guidance Counsellor will return the original registration form which should be kept by the student Confirmation of receipt of registration will be sent to the parent’s email address (or by phone if no email address is provided).
Centre for Lifelong Learning Phone: 519-675-4436 Fax: 519-659-2282 www.cfll.on.ca

Cooperative Education:
Cooperative Education is a credit-earning program that integrates classroom course expectations with practical experience in the workplace. The program is based on an agreement between the school and a business or community organization. It involves the participation of the student, teacher, the co-op employer and placement supervisor.
Summer school cooperative education programs:
 give students the opportunity to take cooperative education if they were unable to do so during the regular school year because of scheduling conflicts;
 provide access to placements in areas such as landscaping, recreation, and hospitality that involve seasonal employment opportunities and that are not available during the regular school year; enable students to earn the compulsory and/or optional credits they need to complete their Ontario Secondary School Diploma (OSSD). These can be the two cooperative education credits required for a Specialist High Skills Major [SHSM];
 can lead to opportunities for employment for the remainder of the summer after the placement is completed or for future summer employment.
Summer school Trade cooperative education process:
 Complete and print the Skilled Trades registration form
 Obtain two teacher references. Pick up a Cooperative Education Teacher Reference form (currently in use at your Catholic secondary school) for the teachers to complete

Copy of credit counselling summary or status sheet (ask your Guidance Counsellor to print off a copy for you)
STUDENT RESPONSIBILITIES:
1.
To have the school-based approval (by your Guidance Counsellor)
2.
To submit with your Guidance Counsellor the completed cooperative education application package (will be forwarded to your skilled trades coop summer school teacher; copy of registration form will be faxed to the Centre for Lifelong Learning)
3.
To have access to a computer to allow for the delivery of blended learning (online learning environment).
4.
To attend MANDATORY Integration In-Class Sessions (refer to schedule)
5.
To attend an interview with the perspective Co-op employer
6.
To follow all rules, regulations and policies of both the employer and the London District Catholic School Board related to dress, health and safety, attendance and work schedule
7.
To work in an appropriate manner, exhibiting good work ethic, initiative and citizenship
8.
To make the employer aware of any special health issues that might impact on your placement (e.g., medication requirements)
9.
To have own transportation to and from your Co-op placement and in-class sessions
10.
To understand this is a credit based co-op, and students should NOT be expected to be paid by their co-op employer
11.
To have all necessary documentation completed in preparation for the cooperative education experience
INFORMATION TO REMEMBER:
 Regular attendance and punctuality are mandatory
 Students and their families must ensure that holidays and other activities do not jeopardize their enrolment status in the Co-op program

Students must complete: a) the pre-placement required hours; b) 8.5 hours per day and 5 days per week in their co-op
placement and c) written assignments to achieve 2 credits.
Cathy Hird, Summer School Administrator
James Martin, Principal, Cathy Hird, Vice Principal
Centre for Lifelong Learning
Alternative, Adult and Continuing Education – 2015 Summer School
Centre for Lifelong Learning – London District Catholic School Board
Phone: 519-675-4436
For Office Use Only:
Excel Inkwell
Fax: 519-659-2282
Confirmed www.cfll.on.ca
Section: