Certificate in Co-Operative Career Experience Application

This is the application for the Certificate in Co-Operative Experience offered by the College of Applied Health Sciences. Please see the college website for additional details about this program and contact information.
* = Required

Application Eligibility

If you are a high school graduate and age 18 or older (or you will be 18 years old by the start of the intended term), please check Yes. If you are not a high school graduate or you will not be 18 years old by the start of the intended term you are not currently eligible for this program.

Yes

No

Please email DHDCoOp@uic.edu for information about eligibility for this certificate program.

Do you have a documented Intellectual or Developmental Disability (I/DD) diagnosis?

Yes

No

I prefer not to answer

Be sure to send documentation of your diagnosis directly to the coordinator for this certificate program at DHDCoOp@uic.edu after submitting this application form. Please not upload diagnosis documentation into this application.

Please email DHDCoOp@uic.edu for information about eligibility for this certificate program.

Intended Term

Please indicate the amount of college-level coursework you have completed.

No college-level coursework

Less than a year (29 or fewer semester hours)

Less than two years (30-59 semester hours)

Less than three years (60-89 semester hours)

Less than four years (90 or more semester hours)

Personal Information

First Name

Preferred First Name

Middle Name

Last Name

Birthdate

Legal Sex

Female

Male

X or Another Legal Sex

Gender

Female

Male

Nonbinary

Gender (if not listed)

Pronouns

He/Him

She/Her

They/Them

Pronouns (if not listed)

Country of Primary Citizenship

Social Security Number

Are you a U.S. Permanent Resident?

Yes

No

Your Contact Information

Email Address

Mobile Phone

Mailing Address

Country

Street

City

Region

Postal Code

Permanent Address

Country

Street

City

Region

Postal Code

Application Suppport

Are you completing this application with a support person?

Yes, with my support person (parent or family member)

Yes, with my support person, personal aide, or assistant (non-family member)

Yes, other (example: Teacher, Counselor, Coach)

No, I am completing this application by myself

Please include information about the person who is helping you fill out the application.

First & Last Name

Relationship to you

Email Address

Phone Number

Illinois Residency

Are you a resident of the state of Illinois?

Yes

No

Will you have lived in Illinois for the 12 months preceding your first term at UIC?

Yes

No

Do you have a parent, spouse or legal guardian residing in Illinois through which you can claim residency?

Yes

No

Please provide the following details for the parent, spouse or legal guardian through whom you are claiming Illinois residency.

Full Name

This is my:

Parent

Spouse

Legal Guardian

How long has this individual been residing in Illinois? (in years or months)

Please provide their Illinois address.

Race & Ethnicity (optional)

Colleges and universities are asked by many groups, including the federal government, accrediting associations, college guides, and newspapers, to describe the ethnic/racial backgrounds of their students and employees. In order to respond to these requests, we ask you to answer the following two questions.

Are you Hispanic or Latino?

Yes

No

Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member:

DeleteSchool _ID_

Institution Name

Degree

Start Date

End Date

Degree/Graduation Date

Institution Location

Country

City

Region

Postal Code

Add another school

When you graduated from high school, what type of diploma or certificate did you receive?

Traditional Diploma

Certificate of Completion

General Educational Development (GED) certificate

Other recognized equivalent certificate

Please indicate the recognized equivalent certificate

You may upload an unofficial copy of your transcripts here.

If you are admitted, official transcripts must be submitted electronically (via the transcript service) or by mail (mailing address at the bottom of this page).

Application Requirements

Personal Statement - Submission of the personal statement will be prompted from your application status page after you submit this application form.

How would you like to provide your Personal Statement?

Audio

Typed Document

Video

2 Letters of Recommendation - After submission of this application form, you will also be prompted from your application status page to provide the email address of references that will submit a letter recommending you for the program. Two are required, and you may optionally indicate a third recommender. The application system will send a request directly to the recommenders to upload their letters.

Recommenders CANNOT be a family member.
Acceptable recommender types include: Teacher, Clergy, Coach, Counselor, Employer.

Miscellaneous

The Co-Op Program offers three areas of focus.Which are you the most interested in?

Arts & Culture

Social Justice, Policy & Leadership

Health & Care across the Lifespan

If you would like to submit your resume, you may upload it here.

What is your first language? Do you speak any other languages?

We are currently unable to offer on-campus housing. Where would you plan on living while attending UIC?

Off-campus independently

Off-campus with parents

Off-campus with other family

Application Fee

A $60 application fee is assessed for undergraduate applications, but is waived under certain circumstances.

Please upload a copy of your IVG Letter.

Please indicate your UIN

Application Submission

The University of Illinois System Privacy Statement explains how the University processes personal information and sensitive personal information, including for persons applying for admission from outside the United States. You are encouraged to read this statement if you have questions about your privacy, including who to contact at the University of Illinois, any rights you may have under applicable privacy laws, and how you can file a complaint.

I consent to the University of Illinois processing my personal information, including my sensitive personal information, in the United States on University of Illinois servers and systems and/or third party servers and systems, including cloud hosted systems.

Click Submit once you've completed the application form above. You’ll see a confirmation message confirming submission of your application. You should also receive an email right away (from admissions@uic.edu) with login details to access your application status page.