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op student_responsibility

Cooperative Education and Internship Program (CEIP)   College of Engineering 

Student Summary of Responsibilities Form

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I have read and understand the policies governing my participation in the Cooperative Education and Internship Program at the University of Massachusetts Dartmouth University and hereby apply for admission. If accepted, I agree to abide by the policy statements and responsibilities listed below as conditions for admission to and continuation in the program.

1.     *    Enter and continue in the Cooperative Education and Internship Program in good faith and in fairness to both my employer and University of Massachusetts Dartmouth.    
2.     *     Maintain a satisfactory academic record with the the University of Massachusetts Dartmouth and a satisfactory job performance record with my employer.    
3.     *     Act in an ethical and professional manner as a representative of the University of Massachusetts Dartmouth and my employer.    
4.     *     Follow the required work session/academic session schedule of the Coop/Internship Program as specified by my College/Department.    
5.     *     Register for each of the required work sessions as specified by my College/Department and pay the required registration and service fee.    
6.     *     Submit the required Evaluation and Work Experience Reports to my Faculty Coordinator immediately after each work session.    
7.     *     Keep a current mailing address, phone number, and Email address with my Faculty Coordinator at all times.    

Last Name      *    
First/Middle Name      *   (First Middle)    
Student Identification Number      *   (NOT your SSN)    
School Email     @umassd.edu  *   
Major        
Coordinator Last Name      *    
Coordinator First/Middle Name      *   (First Middle)    
I understand that under the Family Rights and Privacy Act of 1974, I have the right to inspect and review any records that are sent out of the University directly related to me. I hereby waive these rights regarding my resume, records, grades, or evaluations which:
(1) may be provided to an employer as the basis for my application for Coop/Internship employment;
(2) may be provided to or received from my Coop/Internship employer for the purpose of evaluating my progress while in the Coop/Internship Program.    
Signature      (Please Initial Here)   *    
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