CIS Co-Op Education Application
To be eligible to participate in Cleveland State University's Monte Ahuja College of Business CIS Cooperative
Education program, students must complete the Monte Ahuja College of Business CIS Cooperative
Education Application and submit it to: CIS Department Chair, Monte Ahuja College of Business, 1860 East
18th Street, BU 344, Cleveland, Ohio 44115, or Fax: 216.687.5448, or Email: cisdept@csuohio.edu
LAST NAME:
FIRST NAME:
(Print Clearly)
(Print Clearly)
CSU ID #:
PRIMARY PHONE:
ALT. PHONE:
EMAIL ADDRESS:
(Print Clearly)
STREET ADDRESS:
CITY:
STATE/PROVINCE:
ZIP/POSTAL CODE:
Are you a U.S Citizen or permanent resident?
YES
If NO, what is your visa status?
_____
Are you a FULL-TIME CSU student majoring in
CIS or IST ?
YES
NO
Did you transfer to CSU from another
college/university?
YES
NO
YES
NO
NO
If so, which college/university?
Are you currently employed in a job related to
IT?
If you are currently employed in a job related
to IT, 1) who is your employer & 2)
what is your position title and duties?
EMPLOYER:
CSU CLASS STATUS:
CUMULATIVE GPA**:
(FR, SO, JR, SR)
POSITION TITLE & DUTIES:
(Current)
MAJOR DISCIPLINE:
** If your cumulative GPA is lower than 2.2, you are ineligible for the Cooperative Education option; see the CIS
Department Chair to discuss your options.
Continue to 2nd page (see back of this form)
STATEMENT OF UNDERSTANDING
Terms Circle One YES NO Your Initials 1. I understand this is a 5-­‐year program, alternating school and work, with a defined curriculum and schedule, and any change must be approved by the CIS Co-­‐Op Coordinator 2. I understand I must maintain a 2.2 cumulative GPA to remain in the CIS Co-­‐Op Program 3. If I am a transfer student, I understand I must have completed 8 credit hours of CIS coursework at CSU to be eligible for the Monte Ahuja College of Business CIS Co-­‐Op Program 4. I understand I must complete all required courses in compliance with the Co-­‐Op guidelines established by CSU and the Monte Ahuja College of Business 5. I have completed and passed ("S") CSC 121 or CSC 321 6. I agree to update my CSU Careerline profile and resume each semester 7. I understand I must be registered as a full-­‐time student (minimum 12 credit hours) the preceding semester to the Co-­‐
Op experience 8. I will register for the Co-­‐op Field Experience Course, (CIS 300 or IST 300), for the appropriate semester, when Co-­‐Op placement has been approved and confirmed 9. I will work my scheduled hours per my agreement of employment with the Co-­‐Op Employment Partner. 10. I understand the completion of the Co-­‐Op Learning Objective Report, Co-­‐Op Evaluations and Work Reports is mandatory YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO 11. I understand that some employers’ request Co-­‐Op Program participation verification and I will be responsible for aiding this process YES NO 12. If this is my first Co-­‐Op experience, I agree to attend the Co-­‐Op Orientation session 13. I understand I must complete a minimum of three work periods to qualify my experience as Co-­‐Op 14. I understand that I must submit this application, and I must have the approval of the CIS Department Chair and the CIS Co-­‐Op Coordinator, to be eligible for the Co-­‐Op Program YES NO YES NO YES NO YES NO 15. I agree to communicate with the CIS Co-­‐Op Coordinator, minimally, once per work period YES NO 16. I understand the CIS Co-­‐Op Coordinator will assist in my search for a Co-­‐Op position; however, regardless of how the position is found, I agree to communicate all Co-­‐Op activity to the CIS Co-­‐
Op Coordinator I read, understood and have agreed to comply with the terms and conditions of the Monte Ahuja College of Business CIS
Co-Op Guide: Student’s Signature:
Date:
Department Chair’s Signature:
Date:
CIS Co-Op Coordinator’s Signature
Date: