Name of student, course, year, college_________________________
Host Training Establishment (HTE) _________________________
For CMO. No. 104, s. 2017: Guidelines for Student Internship Program in the Philippines (SIPP) for all Programs with Practicum
BU Requirements
Requirement
A. Letter of request to conduct OJT
addressed to the President
B. Travel Order
CHED Requirements
C. HEI must execute a MOA with the HTE
duty notarized
D. HEI must develop a training manual or
plan which shall be part of the training
contract signed by the trainee and co-
signed by the parent/guardian
E. Monitor and evaluate performance of
the student trainees based on the
prescribed training manual or plan.
F. Conduct general orientation for
qualified student trainees and their
parents/guardians
G. Set criteria on the selection of faculty
practicum coordinator per program for
all aspects of the student internship
programs including program
implementation monitoring and
evaluation
H. Student trainee must be enrolled in a
practicum or equivalent subject
I. The trainee shall be physically,
mentally, and emotionally fit, as a
contained in the physical & psychological
examination certified by DOH accredited
clinics and hospitals
J. Has consent from parents/guardians
K. Insurance of Students
L. Emergency Awareness Plan
Checked by:
____________________
MERRYCHO JUZA C. DUKA
_________________________
Duration of OJT/Affiliation/Internship_________________________
Checklist of Requirements
Subject
Complied
Attachments Yes No Remarks
A.1 Letter of request addressed to University
President prepared/signed by the faculty
professor CSAS and Dean.
B.1 Issued to faculty chaperone(s) who will be
accompanying the student/group during
deployment
C.1 Copy of the duly notarized MOA
D.1 Training Manual or Plan
D.2 Syllabus duly signed by concerned
authorities
D.3 Training Contract duly signed by the trainee
and co-signed by the parent/guardian
E.1 Evaluation Sheet
E.2 Criteria for grading
F.1 Notice of Orientation
F.2 Minutes of the Orientation conducted
F.3 Attendance of the participants
G.1 Copy of the designation of the Faculty
Coordinator
H.1 Certification from the college registrar that
the student is officially enrolled
H.2 Certification from the college registrar that
the students has completed all academic
requirements prior to OJT/Practicum/Affiliation
I.1 Medical Certificate duly certified by the
University Physician
I.2 Psychological test result ( as required by the N/A
HTE or the college)
J.1 Parent/Guardian consent duly notarized
K.1 Individual or group insurance of students
L.1 Do’s and Don’ts of the students before,
during, and after internship
Verified by:
_______________________________ __________________
DR. BABY BOY BENJAMIN D. NEBRES III ROSARIO C. FRICK, RGC
Dean, OSAS Career Placement Coordinator