SCHOOL OF NATURAL SCIENCES

General Luna Road, Baguio City Philippines 2600

Telefax No.: (074) 442-3071 Website: www.ubaguio.edu E-mail Address: sns@ubaguio.edu

APPLICATION FOR MEDICAL TECHNOLOGY/MEDICAL LABORATORY SCIENCE INTERNSHIP

PERSONAL INFORMATION:

ID NUMBER: __20111122__________
NAME: __AARON TZERGIO CERRER GOTOH______________________________________________________
CONTACT NO. : ____09352989210____________________________________________________
CITY ADDRESS: ____CIUDAD GRANDE PHASE 2 BLOCK 2 LOT 8& 9____________________________________________________
PROVINCIAL ADDRESS: ____BENGUET, BAGUIO CITY______________________________________________
NAME OF PARENTS
FATHER: ____TSUGIO GOTOH____________________________________________________
MOTHER: ____ANA LIZA CAMACHO CERRER____________________________________________________
PERSON TO CONTACT IN CASE OF EMERGENCY/GUARDIAN IN BAGUIO CITY
GUARDIAN’S NAME: _JO-AN S. FAUSTINO___________________________________________________
ADDRESS: __307 CAMP 7 KENNON ROAD BAGUIO CITY_________________________________________________
CONTACT NUMBER: __09210361753__________________________________________________
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SELF ASSESSMENT
EXPECTED MONTH OF INTERNSHIP: * JANUARY JULY YEAR: _2021____________
Instruction: Kindly put your grades in the first column if you have already taken the subject/s. Thank you very much.
Grade/ Subject
Descriptive Title of Course REMARKS (for evaluator only)
s Code
FIRST YEAR First Semester
ENGLIS1 Communication Skills 1 (3U)  76
ALGTRI1 College Algebra and Plane Trigonometry(5U)  75
GENZOO1 General Zoology (3U)  81
GENZOL1 General Zoology-Lab (2U)  75
GENCHM1 General & Inorganic Chemistry (3U)  79
GENCHL1 General & Inorganic Chemistry-Lab (2U)  
KOMFIL1 Komunikasyon sa Akademikong Filipino (3U)  75
PESELF1 Self-Testing Activities (2U)  75
SOCORN2 Social Orientation (1U)  P
NSTPRO1 National Service Training Program (3U)  P
Second Semester
ENGLIS2 Communication Skills 2 (3U) 75
FILPPP2 Pagbasa at Pagsulat Tungo sa Pananaliksik (3U) 83
PHILOS1 Logic (3U) 75
ORGCHM2 Organic Chemistry (3U) 79
ORGCHL2 Organic Chemistry (2U) 75
ANAPHY1 Anatomy-Physiology (3U) 78
ANAPHL1 Anatomy-Physiology-Lab (2U) 80
PSYCHO1 General Psychology (3U) 75
PELECT1 PE Elective (2U)
NSTPRO2 National Service Training Program (3U) P
Summer
PHILHS1 Philippine History, Culture and Current Issues (3U) 78
LITRAT1 Phil. Literature (3U) 75
PHIMAN1 Philosophy of Man (3U) 80
NPHYSC1 General Physics (2U) 75
NPHYSL1 General Physics-Lab (1U) 85
SECOND YEAR First Semester
POLSCI5 Politics and Governance (3U) 76
IMTSTS1 Intro to Med Tech w/ Science, Technology & Society (3U)
WLDLIT1 World Literature (3U) 75
MATHEM4 Basic Stat., Stat. Tools w/ Demography (3U) 78
ANACHM1 Analytical Chemistry (3U) 75
ANACHL1 Analytical Chemistry-Lab (2U) 80
BIOCHM2 Biochemistry (3U) 76
BIOCHL2 Biochemistry-Lab (2U) 75
BUSENG1 Business Correspondence and Report Writing (3U) 75
PELECT2 PE Elective (2U)
Second Semester
BUSENG2 Public Speaking with Argumentation & Debate (3U) 83
EDUCTN2 Principles and Methods of Teaching (3u) 75
Community & Public Health (2U) 82
CPHELT1
Community & Public Health with RLE(3U) 82
 SCHOOL OF NATURAL SCIENCES
General Luna Road, Baguio City Philippines 2600

Telefax No.: (074) 442-3071 Website: www.ubaguio.edu E-mail Address: sns@ubaguio.edu

Clinical Chemistry I (3U)

CLNCEM1
Clinical Chemistry I-Lab (1U) 75
Microbiology (3U)
BACTER1 75
Microbiology-Lab (2U)
MTLWBE1 Med Tech Laws & Bioethics (3U) 82
CYGENT1 Cytogenetics (2U) 75
PELECT3 PE Elective (2U) 78
Summer
RIZALJ1 Rizal’s Life & Times incl His Works & Writings (3U) 80
ECONOM1 Health Economics w/ TLR (3U)
SOCANT1 Socio-Anthropology w/ FP (3U) 75
COMPTR1 Comp Fundamentals (3U) 75
THIRD YEAR First Semester
MYCVIR1 Mycology & Virology (2U) 79
General Histology (3U)
GENHST1 75
General Histology-Lab (1U)
METRES1 Methods of Research (3U) 85
Intro to Routine & Spcl Hema (3U) 76
HEMAGY1
Intro to Routine & Spcl Hema-Lab (1U) 76
Immunology & Serology (3U) 75
IMSERO1
Immunology & Serology-Lab (1U) 75
LABOPN1 Laboratory Management, Operation & Instrumentation (3U) 77
Clinical Enzymology (2U)
CLNCEM2 75
Clinical Enzymology-Lab (1U)
Endo., Toxi. & Drug Testing (2U)
CLNCEM3 75
Endo., Toxi. & Drug Testing-Lab(1U)
  Second Semester
Clinical Parasitology (3U)
CLPRST1 77
Clinical Parasitology-Lab (1U)
PREMED2 Immunodeficiency Diseases (2U) 78
Research Paper Writing & Presentation Lab (1u)
RSPWPR1 77
Research Paper Writing & Presentation Lab (1u)
Immunohematology (3U)
IMMHMA1 77
Immunohematology-Lab (1U)
PHARMA1 Pharmacology (3U) 79
Analysis of Urine & Other Body Fluids (3U)
CAUOBF1
Analysis of Urine & Other Body Fluids-Lab (1U)
General Pathology w/ Histopath & Cytologic
GNPATH1 Techniques(2U) 78
GNPATL1 General Pathology w/ Histopath & Cytologic
Techniques(1U) 78
Coagulation and Blood Dyscrasias (2U)
HEMAGY2
Coagulation and Blood Dyscrasias-Lab (1U)

I hereby certify that the above information is true and correct to the best of my knowledge and
belief.
_________AARON
TZERGIO CERRER GOTOH________________
NAME OF STUDENT
(Signature over printed name)

Evaluated by:

_____________________________

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DEAN’S REMARKS

( ) APPROVED ( ) DISAPPROVED

Other Comments:
____________________________________________________________________________________
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 SCHOOL OF NATURAL SCIENCES
General Luna Road, Baguio City Philippines 2600

Telefax No.: (074) 442-3071 Website: www.ubaguio.edu E-mail Address: sns@ubaguio.edu

Ms. TERESA N. VILLANUEVA, RMT, MACT

Dean