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STUDENT INFORMATIONNAME Contact Number
Program of Study E-mail address
Department Chair/Practicum Adviser Section
Original Copies of Documents Set 1
STUDENT INFORMATIONNAME Contact Number
Program of Study E-mail address
Department Chair /Practicum Adviser Section
Date of Enrolment: Start of OJT:
Date of Enrolment: Start of OJT:
COMPANY INFORMATIONNAME OF INSTITUTION Contact Number
Address
Supervisor E-mail address
SUBMISSION CHECKLIST1) Cover Page YES NO2) Company’s Sketch Map from UST YES NO3) Registration Form ( Showing practicum as an enrolled course) YES NO4) Signed Practicum Confirmation and Acceptance Document YES NO5) Waiver Form signed by parents or guardian YES NO6) Valid Identification card of guardian with signature YES NO7) Student’s Waiver Form YES NO8) Medical Certificate from UST Health Service YES NO9) Memorandum of Agreement YES NO
Incomplete requirements will not be accepted.
E-mail address
Photocopies of Documents Set 2
COMPANY INFORMATIONNAME OF INSTITUTION Contact Number
Address
Supervisor
SUBMISSION CHECKLIST1) Cover Page YES NO2) Company’s Sketch Map from UST YES NO3) Registration Form ( Showing practicum as an enrolled course) YES NO4) Signed Practicum Confirmation and Acceptance Document YES NO5) Waiver Form signed by parents or guardian YES NO6) Valid Identification card of guardian with signature YES NO7) Student’s Waiver Form YES NO8) Medical Certificate from UST Health Service YES NO9) Memorandum of Agreement YES NO
Incomplete requirements will not be accepted.