Co-op Position Request Form

Name*
First Last
Trojan ID Number (T#)*
UALR Email*
Phone*
Did you read about The Co-op Process and understand what you read?*
- Yes
- No
If you did not read about The Co-op Process, please do so immediately. If you read about The Co-op Process and did not understand what you read, contact us at careers@ualr.edu for clarification and/or more information.
Have you registered for a Co-Op course when registering for classes this semester?*
- Yes
- No
Note: You must enroll in Co-Op course upon registering for classes for the semester. The course catalog can be found by clicking on the link. https://catalog.ualr.edu/content.php?catoid=20&navoid=2424
Co-Op Course Number*
Co-Op Advisor Name*

Input the name of the instructor who will instruct the Co-Op class.
Co-Op Advisor Phone Number*
Major*
Minor*

If you have not declared a minor, type "N/A".
Have you notified your work supervisor that you want to earn academic credit for your internship or job?*
- Yes
- No
IMPORTANT: Before submitting your form, you must notify your work supervisor that you want to earn academic credit for your work.
Company Name*
Work Supervisor's Name*
Work Supervisor's Work Email*
Work Supervisor's Phone Number
Job Beginning/End Dates
Company Website
What is your job title?*
What are your job duties?*
If you would prefer to attach your duties, type "See Below" and upload your information.
If you would prefer to attach your job duties, upload the attachment(s) here.
Drop files here or

Accepted file types: docx, doc, pdf, Max. file size: 49 MB, Max. files: 5.
Upload Word or pdf documents only.
How many hours per week do you work?*
What is your hourly rate of pay?*
If approved, I agree to regularly check my UALR email for important updates regarding the Co-Op process from my faculty advisor, Co-op Coordinator and others involved in my Co-Op*
- I understand and will regularly check my UALR email for important updates

For issues with submitting the form, contact us at careers@ualr.edu.

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Co-op Position Request Form

Co-op Position Request Form

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