Students Registration Form Submit this Verification / Information form to me by Friday of your 5th week in school! Please select the semester(s) that you will be seeking your next co-op work: FALL    SPRING    SUMMER I    SUMMER II    First Name: Last Name: NU ID: (xxxxxxxxx) Please Select Major: CET EET Please Enter Your Division (if known): Expected Year of Graduation: Current GPA (if available) Please Select Current Status: Freshman Upper Classmen External Transfer Internal Transfer Permanent: City: State: Zip: Permanent Street Address # 1: Permanent Street Address # 2: Permanent Telephone Number: (xxxxxxxxxx)     Local: City: State: Zip: Local Street Address # 1: Local Street Address # 2: Local Telephone Number: (xxxxxxxxxx) Cell Number: (xxxxxxxxxx) E-mail Address:     Please Select Citizenship: U.S. Permanent Resident F-1 J-1 If F-1 or J-1 visa Please Specify Home Country: Emergency Contact Name: Emergency Contact Phone: (xxxxxxxxxx) List scholarship(s) that you have received: List varsity or club sports in which you will be participating: Do you have specific limitations that may have a bearing on your availability for co-op participation? Yes No If Yes, please explain: Do you have a driver's License? Yes No Will you have a car for co-op in Boston? Yes No Will you have a car for co-op at home? Yes No Are you a member of ROTC? Yes No Co-op Location requested? In Eastern MA (planning to commute from immediate NU area) In Eastern MA (planning to commute from my home) Willing to consider other locations Please select one: I am seeking a NEW Co-op Position I plan to return to my PREVIOUS Co-op employer I have completed ALL of my co-op work periods This will be my FIRST Co-op Position By submitting this form, you authorize the Department of Cooperative Education to release to prospective cooperating employers, information relating to your academic performance and cooperative education records when, in the judgment of the faculty of the Department, this information will be of value to your cooperative education or career goals. NOTE: In order for this form to be processed, you MUST click yes! Yes No