RIT
  APPLICATION FOR COOPERATIVE WORK EXPERIENCE
    CREDIT FOR ENGINEERING PROGRAM
       Rochester Institute of Technology
     Kate Gleason College of Engineering
_______________________________________________________

Student Name:

Company Name:

Address:

                   
Major
Program Year (i.e. 3)        
Co-op Block (i.e. 3)        
School Term (i.e. 20032)
Supervisor:

Dept. assigned to:

Student's Title:

Work Dates: to

Hours per week:

Wage Rate: per

For each job experience described below, please identify the level of opportunity
your assignment presented. For only the areas of opportunity that you
experienced, please rate your level of academic preparation including that gained in prior coop experience.
  5 = extensive 5 = excellent
3 = moderate 3 = average
1 = none 1 = poor
Evaluation Categories
Level of Opportunity
Academic Preparation

a) Applied your knowledge of mathematics, science and engineering
Example:

1
2
3
4

5

1
2
3
4

5
b) Designed and conducted experiments as well as analyzed and interpreted data
Example:

1
2
3
4

5

1
2
3
4

5
c) Designed a system, component or process to meet desired needs
Example:

1
2
3
4

5

1
2
3
4

5
d) Worked in a multi-disciplinary team environment
Example:

1
2
3
4

5

1
2
3
4

5
e) Exhibited professional and ethical responsibility
Example:

1
2
3
4

5

1
2
3
4

5

 

 

f) Communicated effectively through written, oral, and graphical means
Example:

1
2
3
4

5

1
2
3
4

5
g) Learned new things during the assignment
Example:

1
2
3
4

5

1
2
3
4

5
h) Used modern techniques and engineering tools
Example:

1
2
3
4

5

1
2
3
4

5
i) Gained awareness of the global and societal impact of your work
Example:

1
2
3
4

5

1
2
3
4

5

 

 

j) Developed, improved, or managed a system/process with people, equipment/ materials, and/or information
Example:

1
2
3
4

5

1
2
3
4

5
k) Level of satisfaction with respect to your professional development expectations
Comments:

1
2
3
4

5

1
2
3
4

5

 
Please answer the following questions related to your co-op experience.

1. Describe briefly your co-op position and major achievements.
    Include job title, projects assigned and assisted, and daily responsibilities.

2. How well did your academic preparation assist you in this position?
    Comment on subject areas that were of the most value (technical and non-technical).
    Comment on subject areas that should be added or strengthened in the curriculum.

3. What contemporary (i.e., new, current) issues were you exposed to in this position?
    Comment on technical, organizational, and social issues.

4. Comment on any positive or negative experiences (professional/personal) related to this position.

Student's Signature  ________________________   Department/Advisor approval _____________________

Email Address   Date ______________________________

NOTE: Before you submit this form, make certain you print a copy of it and bring it along with your employer
evaluation to your advisor for review and approval. Once approved by your advisor, bring it to the ISE
Department Office.