INFORMATION SYSTEMS
IS CO-OP EDUCATION APPLICATION
APPLICATION SUBMISSION PROCESS
To be eligible to participate in Cleveland State University’s Monte Ahuja College of Business IS Cooperative
Education program, students must complete the Monte Ahuja College of Business IS Cooperative Education
Application and submit it to: IS Department Chair, Monte Ahuja College of Business, 1860 East 18th Street,
BU 344, Cleveland, Ohio 44115 or FAX: 216-687-5448 or EMAIL: information_systems@csuohio.edu
Please print clearly if filling out with pen or pencil.
STUDENT INFORMATION
First Name___________________________________________________________________________ Last Name______________________________________________________________________
CSU ID#____________________________________________________________________________________________________________________________________________________________________
Primary Phone______________________________________________________________________ Alt. Number____________________________________________________________________
Email Address____________________________________________________________________________________________________________________________________________________________
Street Address_____________________________________________________________________________________________________________________________________________________________
City________________________________________________________________________________________ State________________________________ Zip Code________________________________
Are you a U.S Citizen or permanent resident?
YES
NO
If NO, which VISA do you possess?______________________________________________________________________________________________________________
Are you a FULL-TIME CSU student majoring in Information Systems?
Did you transfer to CSU from another college/university?
YES
YES
NO
NO
If YES, which college/university?__________________________________________________________________________________ When?_____________________
Are you currently employed in a job related to IS?
YES
NO
If you are currently employed in a job related to IS:
Who is your employer?__________________________________________________________________________________________________________________________________
What is your position title and duties?__________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________________________________
CSU Class Status:
FR
SO
JR
SR
How many credit hours have you earned?______________________________________
Cumulative GPA* (Current)____________________________
*If your cumulative GPA is lower than 2.2, you are ineligible for the Cooperative Education option; please see the
IS Department Chair to discuss your options.
– C O N TINUE TO 2 N D PAGE –
INFORMATION SYSTEMS
STATEMENT OF UNDERSTANDING
TERMS
CIRCLE ONE
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 IS Co-Op Coordinator
YES
2. I understand I must maintain a 2.2 cumulative GPA to remain in the
IS Co-Op Program
YES
3. If I am a transfer student, I understand I must have completed 8 credit
hours of IS coursework at CSU to be eligible for the Monte Ahuja College
of Business IS Co-Op Program
YES
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
YES
5. I understand I must be registered as a full-time student (minimum 12
credit hours) the preceding semester to the Co-Op experience
YES
6. I will register for the Co-op Field Experience Course, (IST 300), for the
appropriate semester, when Co-Op placement has been approved and
confirmed
YES
7. I will work my scheduled hours per my agreement of employment with
the Co-Op Employment Partner
YES
8. I understand the completion of the Co-Op Learning Objective Report,
Co-Op Evaluations and Work Reports are mandatory
YES
9. I understand that some employers’ request Co-Op Program participation
verification and I will be responsible for aiding this process
YES
10.I understand that I must submit this application, and I must have the
approval of the IS Department Chair and the IS Co-Op Coordinator,
to be eligible for the Co-Op Program
YES
11.I agree to communicate with the IS Co-Op Coordinator, minimally,
once per work period
YES
12.I understand the IS 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 IS Co-Op Coordinator
YES
YOUR INITIALS
NO
____________________
NO
____________________
NO
____________________
NO
____________________
NO
____________________
NO
____________________
NO
____________________
NO
____________________
NO
____________________
NO
____________________
NO
____________________
NO
____________________
I read, understood and have agreed to comply with the terms and conditions of the Monte Ahuja College of Business
IS Co-Op Guide:
Student’s Signature
___________________________________________________________________________________________________________
Date________________________________
Department Chair’s Signature______________________________________________________________________________________________ Date________________________________
IS Co-Op Coordinator’s Signature________________________________________________________________________________________ Date________________________________