Student Personal
Information
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Last Name * |
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First Name * |
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Middle Initial |
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IIT Student ID# * |
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Personal Telephone * |
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Personal Email * |
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Work Authorization
Information
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Work Authorization Status * |
U.S. Citizen
U.S. Permanent Resident
F1 Visa
Other (specify)
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SEVIS ID#(if applicable) |
N |
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Student Academic
Information
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Campus * |
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Degree * |
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Major * |
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Academic Advisor * |
Note: Academic advisor is different from CMC advisor. Academic advisor is
usually a professor in your academic department.
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GPA * |
My GPA is above
3.0 and I am eligible for co-op
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Expected Graduation Date * |
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Employment Information
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I confirm that the employment listed below will be taken for one of the following
reasons: * |
To supplement coursework. Mention course(s):
To assist in research/thesis/preparation for qualifying exams
To enhance current coursework with practical application
To fulfill program/course requirements. Mention course(s):
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Company Name * |
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Company Department * |
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Company Address |
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Street Address #1 * |
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Street Address #2 |
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City * |
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State * |
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Zip code * |
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Job Title * |
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Job Description |
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Work Location Address (if different from above) |
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Street Address #1 |
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Street Address #2 |
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City |
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State |
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Zip code |
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Work Telephone * |
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Work Email * |
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Co-op Extension
Information
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Dates of most recent co-op term completed |
From *
To *
Note: If you are an International student, these dates can
be found on the last page of your
I-20.
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Co-op Extension dates |
From *
Your start date
must be at least 8 business days after today. International Students, you cannot resume working
until you have received your updated I-20 Work Authorization from the International Center.
For Main Campus and Downtown Campus
To *
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Number of hours per week * |
Full-time (more than 20 hours/week)
Part-time for
hours/week
Note: Part-time co-op hours combined with any on-campus employment should
not exceed 20 hours/week
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I-20 pick up location * |
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Comments |
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