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Northern Illinois University

Career Services

Internship/Co-op Placement Reporting Form

This on-line form allows Career Services to document the part-time employment successes of NIU students and alumni. It may be filled out by either student/alum or employer. This information is kept confidential.

If you have any questions, please contact Kathie Coulter at (815) 753-8348.

All *fields (required information) must be completed for successful form submission.
Gather pertinent information before you begin the application.

Student Placement Information
* First Name:
* Last Name:
* Major:
* E-Mail:
* Z ID:
DayTime Phone:
Student Job Information
* Job Title:
Hourly Rate:
* Primary Job Duties:
*Describe how this position relates to your major/career path:
Academic Credit?
If Yes, how many hours?

Department:


 
*How was Position Secured:
Check all that apply.
If more than one, hold down CTRL key when selecting.
Semester Placed Check all that Apply
Fall
 Spring Summer
Start Date: Start Date: Start Date:
End Date:   End Date:   End Date:  
Hours per Week: Hours per Week: Hours per Week:
Employer Information
* Employer:
* Contact Name:
Contact Title:
* Contact Address 1:
Contact Address 2:
* Contact E-mail:
If no e-mail is available, please enterN/A
* Contact City:
* Contact State:
* Contact Zip:
* Contact Phone:
Contact Fax: