Students Work Report Form, Engineering Co-op and Career Services, University of Maryland

Students - Work Report Form :

WARNING! Please save your work report to your computer or disk, or print it before you send it; then call our office to make sure we have received it. Occasionally a work report gets lost in cyberspace! Our number is (301) 405-3863. Thank you!

Student Information

First Name:

Last Name:

E-mail Address:

Major:

Degree Pursuing:
(BS, MS, PhD)

Work Information

Employer:

Work Location (City & State):

Name of Immediate Supervisor:

Supervisor's E-mail Address:

Department:

Semester & Year Worked:

Hours per week:

Salary per hour:

What (if any) benefits are provided?

Future Plans

Do you intend to return to your present co-op assignment?

Yes

Undecided

Graduating

If yes, when?

If you are graduating, have you been offered employment by this company?

Yes

If yes, how did you respond to the offer?

I Accepted

I Declined

I am still deciding

Semester Report

For how many terms have you been working for this employer?
One term
Two terms
Three terms
Four or more terms

Select a work term

Answer the following questions regarding your experience this term. Additional space is available by scrolling down each text box.

I give my consent

Yes

Outstanding

Very Good

Average

Marginal

Unsatisfactory

Don't forget to save or print your work report before you send it, then call our office
to make sure we have received it. Our number is (301) 405-3863. Thank you!