Career Development Services

Student Co-op Application

All fields marked with * are mandatory

*First Name:**
Middle Initial:
*Last Name:**
Address*:
City*:
State*:
Zip*:
*Local Address:**
City*:
State*:
Zip*:
*NJIT E-mail Address:**
Home Phone*:
Local/Cell Phone*:
*NJIT Student ID#:**
Major*:
*Co-op Program Desired:**
*Year in School:**
*Graduation Date:**	(MM/YYYY)
Placement Desired: You may select more than one.	Fall I (June â€“ Dec)

	Fall II (Sept â€“ Dec)
	Spring (Jan â€“ June)
	Summer
For Graduate Students Only: Do you currently have or will have a stipend? Yes* No
*Co-op/ Career Objectives:**
Will you accept a work assignment requiring relocation*:	Yes No
*Do you have a valid driver's license:**
*Do you have access to a car:**
Visa Status*:

The information requested here is optional and used solely for the compilation of summary statistics. Your cooperation in supplying this data is appreciated.

Gender:
Military Status:
Person with a Disability:
Please list adaptive support services required at job site:

	Not Specified
	AFRICAN AMERICAN: Persons having origins from any of the Black racial groups of Africa or the Caribbean. Not of Latino origin.
	ASIAN OR PACIFIC ISLANDER: Persons with origins from any of the original people of the Far East, Southeast Asia, the Indian subcontinent, or the Pacific islands.
	CAUCASIAN: White, other than Latino. Persons having origins from any of the original people of Europe, North Africa, or the Middle East.
	LATINO: Persons from Mexico, Puerto Rico, Cuba, Central or South America or other Spanish cultures or origin, regardless of race.
	NATIVE AMERICAN OR ALASKAN NATIVE: Persons with origins from any of the original people of North America and who maintain cultural identification through tribal affiliation or community recognition.
	OTHER:

Please click here to view the Co-op policies.

Accept By submitting this application, I acknowledge that I have read and understand the above Co-op policies and I will abide by and observe these policies. In addition, I hereby authorize the release of all educational records related to me which are maintained by the Division of Career Development Services at the New Jersey Institute of Technology to all potential employers.