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.