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)
Required
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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