Westlane Co-op Pre-Placement Information Form (Spring 2016)
Personal Information
Last Name *
Your answer
First Name *
Your answer
Home Phone Number *
Your answer
Cell Phone Number *
Your answer
Email Address *
Your answer
What grade are you in? *
Do you have a Facebook account? *
How many credits are you scheduled to earn? *
Parent Information
Parent/Guardian name *
If you live by yourself, enter your own name
Your answer
Parent/Guardian phone number *
Your answer
Do you live with your parents? *
Parent/Guardian primary email address
Choose a parent who uses email often
Your answer
What periods of the day do you have co-op this semester? *
(check all that apply including MSIP if you have Mr. Mazzone or Hilliker as your MSIP teacher)
What will be your primary source of transportation to and from your co-op placement? *
Pre Co-op Placement Information
What area would you like to do your co-op placement in? *
ie. automotive, education, health care, dental, technology etc???
Your answer
What high school courses did you take that closely relates to your co-op placement? *
ie. If you are doing a coop placement at "Brock Ford"....you would type transportation assuming you have taken auto
Your answer
Where would you like to do your co-op placement?
If you don't know or have no preference leave this question blank
Your answer
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