Co-op @ Summer School - Late Student Online Application Form 2017
The deadline for our Summer Co-op registration has now passed. We may have some spots available - please complete the following as soon as possible and you will be contacted IF we can fit you in an existing class.

Application Instructions:
You must also submit the paper application form with your parent's signature to your Guidance Counsellor along with two Co-op @ Summer School 2017 Teacher Reference Forms. When you successfully complete this form, the confirmation screen will supply a CODE. Copy this code onto the paper application form.

Note: All applications will be screened through an interview process and applicants MUST attend the interview in April to be considered for this program. Application to the program does not imply acceptance in to the program. Students will receive notification of acceptance following the interview process.

Personal Information
Last Name *
Your answer
First Name *
Your answer
Birth Date (please make sure to pick correct year!) *
MM
/
DD
/
YYYY
Gender *
Home Address *
Your answer
City/Town *
Your answer
Postal Code *
Your answer
Phone - indicate N/A if you don't have a home phone (land line) *
Your answer
Student Cell Phone - indicate N/A if you don't have a cell phone *
Your answer
Student Email Address *
You must check this email regularly, so be sure to use an address that is active, correct, and is professional in nature
Your answer
Home Board *
Home School *
Home School Guidance Counselor
Your answer
OEN *
Please use the format ### - ### - ### and include all 9 digits; check a recent report card if you are unsure.
Your answer
Current Grade *
Expected Graduation - Month and Year *
Your answer
If you are a SHSM student, indicate which SHSM you are enrolled in *
Select all of the statements that apply to you: *
Required
Do you have a medical condition or require accommodations or additional support in order to be successful in this program? If so, please explain. *
Your answer
Did you purchase Student Accident Insurance? *
This is highly recommended - visit www.insuremykids.com for more information
Does your family have private coverage/extended health benefits? *
Employer Contacts/Leads
For City of Guelph students: You may want to login to the SchooltoCareer Active Employer Database for employer suggested options. Logins are available in the guidance office at your home school.

DO NOT DIRECTLY CONTACT EMPLOYERS WHO HAVE JOB ADS IN THE DATABASE. Employers will be surveyed for interest in participation in the program and students will be notified of availability of placements on the first night school pre-employment class.

For North Wellington and Dufferin Students: You must consult the semester 2 co-op teacher regarding availability of placements matching your interests, SHSM co-op requirements, and/or possible co-op arrangements for placements you have made.

Work Placement Interest
What career are you interested in? *
Your answer
How did you become interested in the specific career indicated above? *
Your answer
What, if any, experience (outside of school courses) have you had in this area. Include co-op experience if you took co-op before. *
Your answer
List three (3) reasons why you want to participate in this summer program *
Your answer
Company 1 Information
Students MUST provide contact info for at least one possible placement. If you have spoken to an employer, provide the contact information for this company here. If you haven't spoken to an employer, provide two company suggestions.
Company Name 1 *
Your answer
Contact Name
Your answer
Company Address *
Your answer
City *
Your answer
Phone Number *
Your answer
Contact's Email
Your answer
Have you contacted this person about the possibility of a summer school placement? *
Is this an active co-op employer used by your school? *
Company 2 Information
Provide contact information for a company you would like to do your placement at.
Company Name 2
Your answer
Contact Name
Your answer
Company Address
Your answer
City
Your answer
Phone Number
Your answer
Contact's email
Your answer
Have you contacted this person about the possibility of a summer school placement?
Is this an active co-op employer used by your school?
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