Cooperative Education Contact Form

Please complete and submit the following on-line contact information form.

Your Information: (* = required)

*First Name:

*Last Name:

Cell Phone (xxx-xxx-xxxx):

Home Phone (xxx-xxx-xxxx):

E-mail:

Street Address:

City:

State/Province:

Zip/Postal Code:

†CCRI ID#:

GPA:

Select a semester:

Fall Spring Summer

Campus appointment location:

Are you a veteran?

Yes No

Major:

Do you have a job related to your major that can be used for CO-OP?

Yes No

†Your CCRI ID# is the 8-digit number below your name on your Student ID. The number is also visible within MyCCRI. After logging-in, select: "For Students > Student Schedule". Your ID# will appear on the right-hand part of the "Select Term" screen, to the left of your name.

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