Cooperative Work Study Program


Click here for a printable version of this form and send it to: Tina Moore Director of Career Services Lake Land College 5001 Lake Land Blvd. Mattoon, IL 61938

Date:
06/19/2013
Student Name:	Student ID Number:

Address:

City/State:	Zip:

Phone:	Email:
( ) -
Student Major:	Graduation Date:

Who is your academic advisor?


How many credit hours have you completed at Lake Land College?

What is your grade point average (GPA)?

Do you receive financial aid?
Yes No
If yes, what kind?

Are you currently employed?
Yes No
What length of internship would you like to complete?

When do you want to complete the internship?


What companies are you interested in?

Do you have a current resume and cover letter?
Yes No
List any special requirements or accomodations needed:

Why do you want to participate in the Cooperative Work Study Program?

5001 Lake Land Blvd.
Mattoon, IL 61938-9366
217-234-LAKE