First Name:
Last Name
Title:
Organization:
Website:
Address (address, city, state, zip):
Telephone (xxx-xxx-xxxx):
Email:


For the following 12 questions, fill out as much as you can. 

1. Engineering Contact 1 Name:
2. Engineering Contact 1 Title:
3. Engineering Contact 1 Phone:
4. Engineering Contact 2 Name:
5. Engineering Contact 2 Title:
6. Engineering Contact 2 Phone:
7. Human Resource Contact 1 Name:
8. Human Resource Contact 1 Title:
9. Human Resource Contact 1 Phone:
10. Human Resource Contact 2 Name
11. Human Resource Contact 2 Title:
12. Human Resource Contact 2 Phone:

Organization Product/Services:


Previous participation with GVSU Engineering Co-op Program:
Yes No

Previous participation in any co-op program:
Yes No
If yes, give details:


How many co-op students do you expect to hire this year?
1
2
3
4
5
6+
Not Sure

Semester(s) in which new co-ops could start:

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