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Certificate in Co-Operative Career Experience Application
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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.
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?
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
Fall 2024
Program Default Selection
Co-Operative Career Experience - CERT - Applied Health Sciences
Please indicate the amount of college-level coursework you have completed.
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
Birthdate
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1900
Legal Sex
Legal Sex
Female
Male
X or Another Legal Sex
Gender
Gender
Female
Male
Nonbinary
Gender (if not listed)
Pronouns
Pronouns
He/Him
She/Her
They/Them
Pronouns (if not listed)
Country of Primary Citizenship
Afghanistan
Aland Islands
Albania
Algeria
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Ashmore and Cartier Islands
Australia
Austria
Azerbaijan
Bahamas, The
Bahrain
Bangladesh
Barbados
Bassas Da India
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius, and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Clipperton Island
Cocos Islands (Keeling Islands)
Colombia
Comoros
Congo (Brazzaville)
Congo (Kinshasa)
Cook Islands
Coral Sea Islands
Costa Rica
Cote D'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Europa Island
Falkland Islands (Islas Malvinas)
Faroe Islands
Federated States of Micronesia
Fiji
Finland
Foreign/Unknown
France
French Guiana
French Polynesia
French Southern and Antarctic Lands
Gabon
Gambia, The
Gaza Strip
Georgia
Germany
Ghana
Gibraltar
Glorioso Islands
Greece
Greenland
Grenada
Guadeloupe
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong S.A.R.
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Jan Mayen
Japan
Jersey
Jordan
Juan De Nova Island
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau S.A.R.
Macedonia, Republic of North
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Man, Isle of
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Norway
Oman
Pakistan
Palau, the Pacific Islands of
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Qatar
Reunion
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Spratly Islands
Sri Lanka
Sudan
Suriname
Svalbard
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tromelin Island
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Wallis and Futuna Islands
Western Sahara
Yemen
Yugoslavia
Zambia
Zimbabwe
Social Security Number
Are you a U.S. Permanent Resident?
Are you a U.S. Permanent Resident?
Yes
No
Your Contact Information
Email Address
Mobile Phone
Mailing Address
Mailing Address
Country
Street
City
Region
Postal Code
Permanent Address
Permanent Address
Country
Street
City
Region
Postal Code
Application Suppport
Are you completing this application with a support person?
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?
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?
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?
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:
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?
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:
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:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific
White
Academic History - Please report your secondary (high-school) schooling and any college/university schooling
Delete
School
_ID_
Institution Name
Degree
Business (MBA, MAcc)
High School Diploma
Law (JD, LLM)
Medicine (MD, DO, DVM, DDS)
GED
Associate Degree
Bachelor's Degree
Master's Degree
Doctorate
Start Date
Start Date
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Degree/Graduation Date
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Institution Location
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?
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?
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?
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?
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
What type of activities at the University of Illinois at Chicago interest you? You may select more than one.
What type of activities at the University of Illinois at Chicago interest you? You may select more than one.
Academic Center for Excellence
African American Academic Network (AAAN)
African American Cultural Center (AACC)
Arab American Cultural Center
Army ROTC
Asian American Resource and Cultural Center (AARCC)
Asian American Student Academic Program (AASAP)
Break Through Tech Chicago (BTTC)
Commuter & Off-Campus Life
Counseling Help and Assistance Necessary for a College Education (CHANCE)
Disability Cultural Center (DCC)
Disability Resource Center (DRC)
Equity and Inclusion in Engineering Program (EIEP)
Fraternity and Sorority Life
Gender and Sexuality Center (GSC)
Hispanic Center of Excellence
Latin American Recruitment and Educational Services (LARES)
Latino Cultural Center (LCC)
Leadership and Volunteer Opportunities
Math Sciences Learning Center
Minority Engineering Program
Music - Band
Music - Choir
Music - Jazz Band
Music - Orchestra
Native American Support Program (NASP)
Office for Undergraduate Research
Science Learning Center
Service Leaders
Sports (Club/Intramural)
Student Activities Board
Student Government
Study Abroad
Summer College
Theatre - Acting
Theatre - Design
TRIO: Academic Support Program
Tutorium for Intensive English
UIC Radio
UIC Speech
Undergraduate Success Center
Urban Health Program
Woman in Science and Engineering (WISE)
Women's Leadership and Service Center (WLRC)
Application Fee
A $60 application fee is assessed for undergraduate applications, but is waived under certain circumstances.
If you qualify for a waiver of the application fee by matching one of the choices listed below, please select the appropriate waiver option from this list.
If you qualify for a waiver of the application fee by matching one of the choices listed below, please select the appropriate waiver option from this list.
Not Applicable
Enrolled at UIS
Enrolled at UIUC
FEMA-designated area due to hurricane or wildfire
Illinois Veteran Grant Recipient
UIC Specific Free Application
University of Illinois Employee
Zero EFC
Departure due to Political Conflict/Duress - Ukraine
Other
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.
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.
Submit