VIRTUAL INTERNSHIP OF STUDENTS BY MENTORSHIP OR APPRENTICESHIP (VISMA) FORM

Student Name:
Student Number:
Program:
School:
Course and section:
OJT Course Adviser:
Name of OJT
Mentor and Current
Position

I do hereby voluntarily undergo a Virtual Internship of Students by Mentorship or

Apprenticeship (VISMA) program as my on-the-job training under the following terms and
conditions:

Agreed Work Assignment:

Work Assignment Applicable Credit Hours Required Submission
(Scope of Work)
1.
2.
3.
* Add as many rows as required

WITH OUR CONSENT:

____________________ ____________________
STUDENT TRAINEE PARENT/GUARDIAN
Signature over printed name Signature over printed name
APPROVALS:

____________________________
OJT Mentor
Signature over printed name

____________________________ ____________________________
OJT Course Adviser School DEAN/Associate Dean
Signature over printed name Signature over printed name

_____________________________________

Director, Int’l Career and Exchange Programs

Signature over printed name