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					                                                                        Current Semester:                    Year:




   Career Management Center                                                   Please specify which semesters you are working:
                                                                   Spring 20_                 Summer 20_              Fall 20____




                      Graduate
  Cooperative Education/Internship Registration Form
 Today’s Date:


 Last Name:                                                         First Name:                                      Poly I.D. #:


 Poly E-mail Address:                                               Other E-mail Address:


 Street Address:                                                                      City:                          State:         Zip:


 Home Phone:                                      Cell Phone:                                       Major:


                                                                                      Expected Graduation Date:                     GPA:
 Status:  Full-time Student            Part-time Student

 Are you an International Student?        Yes    No

 Are you a:         U.S. Citizen    Permanent Resident         F-1       J-1       Other (specify)



                      To be eligible to participate in the Graduate Co-op/Internship Program:

   Must be a full-time NYU-POLY Student
   Must have completed at least two semesters
   Must have a GPA of at least 3.0


 To register for the Co-op/Internship Program:
   Complete Co-op/Internship Registration Form (page 1) and both copies of the Student Agreement (page 2 & 3)
   Follow directions on page 4 carefully



        Return Pages 1-3 to Career Management Center (JB359) in person or via email to mtriest@poly.edu.
  Return Page 5 to Prof. Robert Albano in - person to RH 614, OR Page 5 may be emailed to him, ralbano@poly.edu
                                     from supervisor’s business email account.




                                                    Career Management Center
                                                 POLYTECHNIC INSTITUTE OF NYU
Six MetroTech Center  Jacobs Building 359  Brooklyn, New York 11201                Phone: (718) 260-3650  Fax: (718) 260-3325




                                                                          1
                                                                                                                      Office Copy




 Career Management Center


                          Graduate
        Cooperative Ed./Internship Student Agreement
 Students must agree to follow these rules and procedures for the Co-op/Internship Program:
   I authorize Career Management Center to release my resume and unofficial transcript to prospective employers
   as necessary when co-op/employment opportunities arise.

   I will contact my Co-op/Internship Counselor at the beginning and end of each semester to inform her/him of my current
   situation and status, and to complete any necessary paperwork.
   Once I accept a co-op/internship position, I will notify my Co-op/Internship Counselor immediately to register for this
   work experience. I understand that if I do not notify my Co-op/Internship Counselor within one month of accepting a
   position, I will not receive a notation for this work experience on my transcript.
   If I am an international student in F-1 or J-1 visa status, I understand that I am required to obtain permission from
   the Office of International Students and Scholars before each period of co-op/internship work experience.

   While working at co-op/internship employment, I will behave in a professional manner, perform all responsibilities
   to the best of my ability, and abide by all regulations set in place by my employer.

   I acknowledge that my acceptance of co-op/internship employment is a serious commitment to the university and the employer.
   I am aware that I will be expected to work for the duration of the semester and I will not continue to interview
   or accept a job offer at another company for that period of time.

   If I have any problems or concerns while on the job, I will consult with Career Management Center to obtain advice.
   I understand that Career Management Center and Cooperative Education will make every effort to help me find
   a co-op/internship position, but they cannot guarantee such an assignment.
   I understand that Career Management Center and Cooperative Education reserves the right to refuse to distribute
   resumes that are inaccurate, sloppy, or inappropriate in any way.

   I have received a copy of this form for my personal records.


 I certify that I have read and understand the terms of this agreement. I understand that failure to abide by
 these rules and regulations may result in my termination from the Co-op/Internship Program.

 Last Name                                                        First Name

 Student’s Signature                                                                       Date

 Career Management Center Signature                                                        Date




                                                 Career Management Center
                                              POLYTECHNIC INSTITUTE OF NYU
Six MetroTech Center  Jacobs Building 359  Brooklyn, New York 11201           Phone: (718) 260-3650  Fax: (718) 260-3325

                                                                    2
                                                                                                             Student Copy



 Career Management Center
                          Graduate
        Cooperative Ed./Internship Student Agreement
 Students must agree to follow these rules and procedures for the Co-op/Internship Program:
   I authorize Career Management Center to release my resume and unofficial transcript to prospective employers
   as necessary when co-op/employment opportunities arise.

   I will contact my Co-op/Internship Counselor at the beginning and end of each semester to inform her/him of my current
   situation and status, and to complete any necessary paperwork.
   Once I accept a co-op/internship position, I will notify my Co-op/Internship Counselor immediately to register for this
   work experience. I understand that if I do not notify my Co-op/Internship Counselor within one month of accepting a
   position, I will not receive a notation for this work experience on my transcript.
   If I am an international student in F-1 or J-1 visa status, I understand that I am required to obtain permission from
   the Office of International Students and Scholars before each period of co-op/internship work experience.

   While working at co-op/internship employment, I will behave in a professional manner, perform all responsibilities
   to the best of my ability, and abide by all regulations set in place by my employer.

   I acknowledge that my acceptance of co-op/internship employment is a serious commitment to the university and the employer.
   I am aware that I will be expected to work for the duration of the semester and I will not continue to interview
   or accept a job offer at another company for that period of time.

   If I have any problems or concerns while on the job, I will consult with Career Management Center to obtain advice.
   I understand that Career Management Center and Cooperative Education will make every effort to help me find
   a co-op/internship position, but they cannot guarantee such an assignment.
   I understand that Career Management Center and Cooperative Education reserves the right to refuse to distribute
   resumes that are inaccurate, sloppy, or inappropriate in any way.

   I have received a copy of this form for my personal records.


 I certify that I have read and understand the terms of this agreement. I understand that failure to abide by
 these rules and regulations may result in my termination from the Co-op/Internship Program.

 Last Name                                                        First Name

 Student’s Signature                                                                       Date

 Career Management Center Signature                                                        Date




                                                 Career Management Center
                                              POLYTECHNIC INSTITUTE OF NYU
Six MetroTech Center  Jacobs Building 359  Brooklyn, New York 11201           Phone: (718) 260-3650  Fax: (718) 260-3325


                                                                    3
Career Management Center


                      Graduate
Cooperative Ed./Internship Job Acceptance Check List
      Prior to the start of employment students need to perform the
                                    following tasks:


     Obtain Co-op/Internship offer letter from prospective employer with the following information:

              o   job title
              o   detailed job description
              o   start and end dates
              o   salary
              o   work location
              o   number of hours per week of work
              o   supervisor’s name, email, mailing address & phone number

     Have Supervisor sign the “Cooperative Ed./Internship Student/Supervisor Guidelines Form” (Attachment A)

     Register for the appropriate Cooperative Ed./Internship work experience

              o   1st Co-op/Internship Experience: CP 991
              o   2nd Co-op/Internship Experience: CP 992
              o   3rd Co-op/Internship Experience: CP 993

     Print copy of transcript after registering for Cooperative Education/Internship work experience

     Submit offer letter, signed Guidelines Form and copy of transcript to Professor Albano (Room RH 614)

     International Students: After obtaining a memo from the Advisor you must visit the Office of International Student
     and Scholars (RH 321) (International students in F-1 or J-1 visa status are required to obtain permission from the
     Office of International Students and Scholars before each period of co-op/internship work experience)

     A midterm employer evaluation, final employer evaluation and final report of the Co-op/Internship experience are
     required to be submitted to the Advisor (room RH 614). Professor Albano will provide the midterm and final
     evaluation to your supervisor and your supervisor should submit them directly via email to him at ralbano@poly.edu.




                                              Career Management Center
                                           POLYTECHNIC INSTITUTE OF NYU
Six MetroTech Center  Jacobs Building 359  Brooklyn, New York 11201    Phone: (718) 260-3650  Fax: (718) 260-3325

                                                              4
                                                                                                      (Attachment A-Rev 1.01)


Career Management Center

                                Graduate
      Cooperative Ed./Internship Student/Supervisor Guidelines Form
    THIS MUST BE COMPLETED BY THE STUDENT AND HIRING SUPERVISOR BEFORE RECEIVING INTERNSHIP
                                           APPROVAL

The student and supervisor, by signing below, acknowledge that they are responsible for the following:
   1. The student agrees to provide the Co-op/Internship advisor with a copy of the offer letter containing
       their supervisors name, title, address, phone number & email address prior to starting the Co-
       op/Internship.
   2. The supervisor agrees to complete an Employer Evaluation form at the half-way point and an
       Employer Evaluation form1 upon the completion of the Co-op/Internship. Signed and dated copies
       are to be forwarded to the Co-op/Internship advisor within 5 days of each time frame.
   3. The student agrees to submit a final report that describes the technical observations, challenges
       encountered, solutions developed, and outcomes to the Co-op/Internship advisor within 5 days of
       the completion of the Co-op/Internship.
           a. Polytechnic Institute of NYU requires that the student will share their final report with their
               supervisor for approval so that proprietary and/or confidential information can be removed
               before submitting it to the Co-op/Internship advisor.
   4. If any of the above items are not fulfilled, within the time specified, the student will be assigned an
       unsatisfactory grade and the internship will be cancelled.
   5. If the student does not receive an I-20 or decides not to take the assignment, they must advise the
       Co-op/Internship advisor, otherwise they will receive an unsatisfactory grade.
   6. The internship must be for a minimum of eight weeks and 240 hours.
   7. Internship must comply with the Fair Labor Standards Act (FLSA) through the U.S. Dept. of Labor.
       www.dol.gov

                Start Date :_______________

                Finish Date:_______________

Student Name (please print) __________________________________________________

Students Signature_________________________________________________________

Supervisor Name (please print) ________________________________________________

Supervisors Phone_____________________Email________________________________

Supervisors Signature_______________________________________________________
All questions and documentation should be directed to:
Prof. Robert Albano
6 Metro Tech Center, RH 614, Brooklyn, NY 11201
718-260-3835 or ralbano@poly.edu



1
    Use either the form provided by Polytechnic Institute of NYU or your own for the Employer Evaluation
                                                                   5

				
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