Work-Based Learning Questionnaire

Please complete the REQUIRED questionnaire below before you meet with the Internship and Co-op Coordinator for an individual appointment. If you have not yet viewed the orientation video and information you must also do so by clicking here.

To schedule an appointment, contact the office by phone 440-366-4076, email careers@lorainccc.edu, or in person at Employment and Career Services on the first floor of the Community Resource Center.

You must also register in the CareerLink Job, Internship and Co-Op Database before your appointment.

First Name

Last Name

Phone

E-Mail

Are you a current LCCC or UP student?

Yes

Student Number

Your degree or major

Number of credit hours completed

Grade point average

Are you seeking credit for a current work experience?

Yes

Questions/Comments

Work-Based Learning Questionnaire

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