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WBS/Co-op Student Survey Form - 22-23SY
Please complete the form for consideration into the WBS program. Once the survey is complete, the WBS Coordinator will review and discuss with the program instructor. THIS is not the paperwork for a co-op placement.
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* Indicates required question
Shop and CIP Code
*
Choose
Allied Health 51.0899
Automotive Technology 47.0604
Baking Pastry Arts 12.0501
Building Trades 46.0401
Collision Repair 47.0603
Cosmetology 12.0401
Culinary Arts 12.0508
Early Childhood Education 19.0708
ERST
Health Care Science 51.0899
Landscape Construction 01.0601
Networking 11.0901
Public Safety 43.0107
Teacher Academy
Transition to Career
Visual Communications 50.0402
Video, Sound and Music 10.9999
Year of Graduation
*
Choose
2023
2024
Last Name
*
Your answer
First Name
*
Your answer
Cell Phone
*
Your answer
Personal Email Address (no school emails)
*
Your answer
Parent(s) Name, Email & Phone
*
Your answer
Have Own Transportation
*
Yes
No
Other:
Student Age (if 17 yo, need a work permit)
*
17
18
Over 18
Required
Employer
*
Your answer
Employer Contact Name
*
Your answer
Phone
*
Your answer
Employer Email Address
*
Your answer
Employer Street Address
*
Your answer
Employer City
*
Your answer
Employer State
*
PA
NJ
DE
Employer Zip
*
Your answer
Job Title
*
Your answer
Pay Rate
*
Your answer
How long have you worked for your employer? (Approximate date)
*
Your answer
CMTHS Parking Pass
*
Choose
Yes
No
Submit
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