Student Application Form

Please Note: If you are unsure of any of the information requested in the form below, just leave the field blank and move on to the next field. We can "fill in the blanks" when we meet with you in person. The only mandatory fields are those marked with a red *. If you have any difficulty completing this form, please contact Molly at molly.degenhardt@uleth.ca for assistance.

Have you had a first appointment with a Co-op Coordinator?:

Yes

Co-op Coordinator:

N/A

Diana

Jasminn

Stacey

Please select the name of the Co-op Coordinator you met with for your first appointment.

Student Name: *

Student ID #: *

Please enter your University of Lethbridge Student ID Number.

Date of Birth: * (mm/dd/yy)

SIN (Social Insurance Number):

Current Address: *

Please include, Street Address, City/Town, Province, Postal Code.

Current Phone:

U of L E-mail:

Cell Phone:

Secondary E-mail:

Permanent Address:

Please include, Street Address, City/Town, Province, Postal Code.

Permanent Phone:

Do you hold a valid Driver's Licence?:

Citizenship:

Canadian Citizen

Landed Immigrant

Student Visa

Are you legally entitled to work in any other countries?:

If you are entitled to work in any other countries, please list them here.

Faculty of Arts & Science
Co-operative Education & Internships

Students