College of Engineering & Applied Science
Co-op Learning Plan – Form D
This agreement must be completed, signed and returned to your co-op coordinator in order to ensure a high quality experience and satisfaction among all parties, as well as to satisfy one of the requirements of your approved college co-op.
Make sure that you read the responsibilities under this agreement at the end of the Co-op
Learning Plan, print everything out, obtain the required signatures, and return the form to your college co-op coordinator.
Questions should be directed to your college co-op coordinator.
L STUDENT INFORMATION L
Name _______________________________________ Student I.D. Number_______________
Last First
E-mail_______________________________________ Phone ( ) ____________________
Address_______________________________________________________________________
Street City State Zip
Class Standing (circle one): FR SO JR SR SR5
Primary Major:

Aerospace

Applied Math

Architectural

Chemical

Chemical & Biological

Civil



Electrical & Computer

Engineering Physics


Computer Science
Electrical
Environmental
Mechanical
Expected Date of Graduation _______________________
L EMPLOYER INFORMATION L
Company Name ________________________________________________________________
Supervisor _______________________ E-mail______________________________________
Phone ( ) _____________________ Fax ( ) ______________________
Address_______________________________________________________________________
Street City State Zip
Page 1 of 4

College of Engineering & Applied Science
Co-op Learning Plan – Form D
L CO-OP INFORMATION L
Position Title___________________________________________________________________
Start Date______________________________ End Date _____________________________
Planned Hours Work/Week________ Salary__________ Per Hour  Per Week  Per Month
For the following questions, please be as specific and complete as possible.
1.
Describe the nature of your position and/or your duties.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
2.
What do you hope to learn from this experience?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
3.
How are you going to accomplish your educational objectives? Discuss projects, readings, writings, etc.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
4.
How will you evaluate the learning experience? What evidence will you provide to document your accomplishments?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Page 2 of 4

College of Engineering & Applied Science
Co-op Learning Plan – Form D
5.
How often will you be evaluated by your supervisor?
 Weekly Monthly
By what method:

Written Evaluation

Face-to-Face Meeting

Both Written and Face-to-Face

Other (please specify) ________________________________
 Other__________
L RESPONSIBILITIES UNDER THIS AGREEMENT L
When signing this agreement, you agree to assume the responsibilities listed for your role.
I, the co-op student, agree to:
1.
Perform to the best of my ability those tasks assigned by my supervisor which are related to my learning objectives and the responsibilities of this position.
2.
Follow all the rules, regulations, and normal requirements of the employer’s organization.
3.
Notify my co-op coordinator of any changes I need to make in this plan or of any problems that develop during the placement.
4.
Complete an evaluation of my co-op experience at the conclusion of the co-op term.
I, the employment supervisor, agree to:
1.
Provide the necessary orientation, training, precautionary safety instructions, and supervision in the performance of the position duties and responsibilities as listed above.
2.
Understand the responsibility for providing Worker’s Compensation and liability insurance in accordance with Colorado state law, and agree to provide said coverage.
3.
Complete a final written evaluation of the student’s performance at the completion of the coop term.
I, the college co-op coordinator, agree to:
1.
Act as a liaison between the student and the employing organization.
2.
Assist the student and employment supervisor in resolving any problems or difficulties which may arise.
3.
Help students to write plans that specify measurable learning objectives when requested.
According to C.R.S. 8-40-302(7)(a):
Any employer, as defined in section 8-40-203, who enters into a bona fide cooperative education or student internship program sponsored by an educational institution for the purpose of providing on-the-job training for students shall be deemed an employer of such students for the purposes of workers' compensation and liability insurance.
Page 3 of 4

College of Engineering & Applied Science
Co-op Learning Plan – Form D
The student, employer, and college co-op coordinator agree to assume these responsibilities for the duration of the student’s placement. This Co-op Learning Plan must be completed in order for the College of Engineering and Applied Science to endorse the student’s placement, and for the student to receive credit for the co-op.
Please secure signatures in sequence.
Your signature means that you have read, understand and agree to this plan.
1.
Student ______________________________________________ Date _______________
2.
Employment supervisor _________________________________ Date _______________
3.
College co-op coordinator _______________________________ Date _______________
Page 4 of 4