Statement of Cooperation

Statement of Cooperation

CE100 - Cooperative Education (Work Experience)
Palomar College 1140 W. Mission Rd. San Marcos, CA 92069-1487 (760) 744-1150 x2354 Fax: (760) 761-3503
Statement of Cooperation
Student Full Name*
Student Email*
The email address used for Work Experience Correspondence
Palomar ID #*
Company Name*
Where do you work?
Business Address (Actual Location)*
Class number
Supervisor Name*
Must be someone in a higher position than you
Units
Semester/Year
BEGINNING of SEMESTER: Set Learning Objectives
For each semester that a student is enrolled in Cooperative Education, it is necessary to identify new or expanded SMART job- oriented learning objectives (specific, measurable, attainable, relevant, and time sensitive). These objectives are developed by the student and then reviewed and approved by both the supervisor and instructor-coordinator. Should an objective require revision during the semester, the instructor-coordinator must be notified. The student/employee and the supervisor will evaluate objective accomplishments at the end of the course term.
Please type the 3 Learning Objectives that you and your supervisor have established that you will be working on this semester.
Objective 1
Objective 2
Objective 3
STATEMENT OF COOPERATION AGREEMENT

The student will comply with the Cooperative Education program guidelines and regulations. The employer and the college will provide necessary supervision and counseling to insure that the student/employee receives appropriate educational benefit from this work experience. The instructor-coordinator will visit the student/employee's place of employment, consult with the employer regarding the student's job performance, and grant academic credit for successful completion of the program. It is understood the employer will, as required by law, comply with all appropriate federal and state regulations. Students will be accepted and assigned to jobs and otherwise treated without regard to race, color, national origin, sex, or handicap. The undersigned agree with the validity of the job- oriented learning objectives listed below. You can sign by physical signature, electronic signature, or typed signature below. If you sign electronically or by typed signature, you are agreeing that this form of signature is the equivalent of your physical signature.
Acknowledgement that you have read the information above and agree. This is also acknowledgement that you have spoken with your employer, and that both of you agree that you will be working on the 3 learning objectives stated above.

You can sign by typing signature below. If you type the signature, you are agreeing that this form of signature is the equivalent of your physical signature.
Student Signature
Can be a typed signature
Date

MonthDayYear
Date
Supervisor's Signature
Can be a typed signature
Date

MonthDayYear
Date
Instructor Signature (Palomar)
Date

MonthDayYear
Date
Should be Empty:

Statement of Cooperation

Statement of Cooperation

BEGINNING of SEMESTER: Set Learning Objectives

STATEMENT OF COOPERATION AGREEMENT