The information requested will be shared with your Stout Mentor and be used in preparing the Co-op Annual Report. It is important that your answers are frank, complete, and responsible.
* Information to be recorded on transcript
Student Name:
Stout ID#:
Student E-mail:
Major/Minor:
Stout Mentor:
*Employer Name:
*Employer Location:
*Co-op Position Title:
Dates of Co-op Assignment:
to (mm/dd/yy)
Average hours worked per week:
Pay rate/Hr:
If you received a pay increase, please provide your highest salary. Also, if you were being paid in increments other than hourly, please divide the money made by the hours worked and enter the hourly rate.
1. How valuable was this work
experience to you in:
(rate on a scale of 1-5; 1 = no value, 5 =
very valuable NA=No Answer)
a. Helping you decide on your future career (in this area or a different area)?
b. Providing insight into your employer's business or operation?
c. Learning new skills or techniques?
d. Clarifying your future educational goals?
e. Applying, integrating, or making relevant the knowledge gained from your courses?
2. Did you recieve a job offer from your Co-op employer?
Yes
No
3. Did you recieve a job offer from a contact/vendor of your Co-op employer?
Yes
No
4. Indicate what you feel are the strong points or highlights of your work experience at your company.
5. Indicate changes that would have made your work experience more meaningful.
6. In what way(s) was this work assignment meaningful to your academic program?
7. Do you feel a student should possess any special qualifications or requirements for this assignment? Yes No
If yes, please explain:
8. Did you receive enough assistance from your work site supervisor?
Yes No
If no, how could he/she have helped more?
9. Would you recommend this employer for future Co-ops?
Yes No
If no, please explain.
10. Other remarks.
Please print a copy of this form after it is filled in for your own records.