Appendix 6

SIR WINSTON CHURCHILL
CO-OPERATIVE EDUCATION DEPARTMENT

SPECIAL CONFERENCE/WORK APPLICATION

WORK PLACEMENT: _________________________________________________

PLACEMENT SUPERVISOR: ___________________________________________

CO-OP TEACHER: ____________________________________________________

NORMAL PLACEMENT HOURS: ________________________________________

STUDENT NAME: ____________________________________________________

ABSENT FROM CLASS ON: ____________________________________________
(DATE AND HOURS)

PLEASE INDICATE BELOW IF YOU WILL ALLOW THIS ABSENCE FOR EDUCATIONAL PURPOSES.

TEACHER # 1: _________________________________________________________

TEACHER # 2: _________________________________________________________

CO-OP TEACHER: ______________________________________________________

THANK YOU FOR YOUR CO-OPERATION.
THE CO-OP DEPARTMENT.