PRACTICUM

BEFOREPROCESS
OJT LA SALLE UNIVERSITY Document No:
ROF-VCAC-OJT-1714
BEFORE OJT Ozamiz City Issue No.: Revision No.:
STEP 1. Evaluation of pre-requisite courses for practicum (secure OFFICE OF THE PRACTICUM PROGRAMS 01 2
academic records from the Registrar’s Office) Effective Date: Page
Document Title: PRACTICUM APPLICATION FORM October 2017 1 of 1
Program Head ______________________________ ________
PRINTED NAME AND SIGNATURE DATE
This is to formalize my intention to take the practicum subject. Please find pertinent information on my application.
STEP 2. Join orientation and submit the following required
documents I. PERSONAL INFORMATION Date of filing: _______ Name: _________________________________
2.1 ⃝ Complete practicum application form Course: ___________________________ Major: __________________________ Year Level: ______
2.2 ⃝ Application Letter & Resume
2.3 ⃝ Complete Medical check-up (CBC, Urinalysis, Fecalysis, X-ray test)
Gender: _____ Age: ___ Civil Status: ________ Birth Date: _________ Telephone No.:___________
2.4 ⃝ Drug Test 2.6 ⃝ Medical Certificate Mobile No: No.: _____________________ Email Address: _________________________________
2.5 ⃝ Pregnancy Test (for females)
Practicum Coordinator ______________________________ ________ II. PRACTICUM TRAINING DETAILS
PRINTED NAME AND SIGNATURE DATE
YOU ARE NOW READY FOR ENROLLMENT! □PRACTICUM 1 Term: □1ST □2ND □SUMMER
STEP 3. Provide a complete name and address of Host Training PRACTICUM PLACEMENT: □International □National □Regional □Local City/Town: ________________________
Establishment and secure the necessary documents from the
practicum office.
3.1 ⃝Practicum Agreement 3.6 ⃝Endorsement Letter Training Establishment Address Contact No.
3.2 ⃝Waiver and Permission Form 3.7 ⃝Company Acceptance Letter *
3.3 ⃝ Internship Waiver 3.8 ⃝Practicum Evaluation Form
3.4 ⃝ Duties and Responsibilities 3.9 ⃝OJT Documentation Template
3.5 ⃝ Memorandum of Agreement *
NOTE: All documents must be sent to lsupracticumoffice@lsu.edu.ph
Practicum Coordinator ______________________________ ________ Duration of Training (hours): _________ Start Date: _________________ End Date: _________________
PRINTED NAME AND SIGNATURE DATE
STEP 4. Approval of the College Dean
College Dean ______________________________ ________ □PRACTICUM 2 Term: □1ST □2ND □SUMMER
PRACTICUM PLACEMENT: □International □National □Regional □Local
PRINTED NAME AND SIGNATURE DATE
Step 5. Proceed to practicum adviser. City/Town:
Practicum Adviser _____________________________ _______ ___________________________
PRINTED NAME AND SIGNATURE DATE

YOU CAN START YOUR OJT. Training Establishment Address Contact No.
AFTER OJT
Step 1. Submit photocopies of DTR & Certificate of completion to
the Registrar’s Office.
Registrar ______________________________ ________
PRINTED NAME AND SIGNATURE DATE
Step 2. Submit Practicum Evaluation to practicum adviser. Duration of Training (hours): _________ Start Date: _________________ End Date: _________________
Practicum Adviser ______________________________ ________
PRINTED NAME AND SIGNATURE DATE
III. CONTACT DETAILS Contact person in case of emergency
STEP 3. Submit the ff. scanned copies to Practicum Coordinator
⃝ Practicum Evaluation* ⃝ Copy of Certificate of completion
Name: _____________________________________ Relationship: __________________________
⃝ Copy of DTR ⃝ OJT Documentation * Mobile No.: ______________________________ Telephone No.: __________________________
Practicum Coordinator ______________________________ ________
Home Address: ____________________________________________________________________
PRINTED NAME AND SIGNATURE DATE Company Address: _________________________________________________________________
NOTE: All documents must be sent to lsupracticumoffice@lsu.edu.ph

PRACTICUM PROCESS LA SALLE UNIVERSITY Document No:

ROF-VCAC-OJT-1714
BEFORE
BEFOREOJTOJT Ozamiz City Issue No.: Revision No.:
STEP 1. Evaluation of pre-requisite courses for practicum (secure OFFICE OF THE PRACTICUM PROGRAMS 01 2
academic records from the Registrar’s Office) Effective Date: Page
Document Title: PRACTICUM APPLICATION FORM October 2017 1 of 1
Program Head ______________________________ ________
PRINTED NAME AND SIGNATURE DATE
This is to formalize my intention to take the practicum subject. Please find pertinent information on my application.
STEP 2. Join orientation and submit the following required
documents I. PERSONAL INFORMATION Date of filing: _______ Name: _________________________________
2.1 ⃝ Complete practicum application form Course: ___________________________ Major: __________________________ Year Level: ______
2.2 ⃝ Application Letter & Resume
Gender: _____ Age: ___ Civil Status: ________ Birth Date: _________ Telephone No.:___________
2.3 ⃝ Complete Medical check-up (CBC, Urinalysis, Fecalysis, X-ray test)
2.4 ⃝ Drug Test 2.6 ⃝ Medical Certificate Mobile No: No.: _____________________ Email Address: _________________________________
2.5 ⃝ Pregnancy Test (for females)
Practicum Coordinator ______________________________ ________ II. PRACTICUM TRAINING DETAILS
PRINTED NAME AND SIGNATURE DATE
YOU ARE NOW READY FOR ENROLLMENT! □PRACTICUM 1 Term: □1ST □2ND □SUMMER
STEP 3. Provide a complete name and address of Host Training PRACTICUM PLACEMENT: □International □National □Regional □Local City/Town: ________________________
Establishment and secure the necessary documents from the
practicum office.
3.1 ⃝Practicum Agreement 3.6 ⃝Endorsement Letter *
Training Establishment Address Contact No.
3.2 ⃝Waiver and Permission Form 3.7 ⃝Company Acceptance Letter
3.3 ⃝ Internship Waiver 3.8 ⃝Practicum Evaluation Form
3.4 ⃝ Duties and Responsibilities 3.9 ⃝OJT Documentation Template
3.5 ⃝ Memorandum of Agreement *
NOTE: All documents must be sent to lsupracticumoffice@lsu.edu.ph
Practicum Coordinator ______________________________ ________ Duration of Training (hours): _________ Start Date: _________________ End Date: _________________
PRINTED NAME AND SIGNATURE DATE
STEP 4. Approval of the College Dean
College Dean ______________________________ ________ □PRACTICUM 2 Term: □1ST □2ND □SUMMER
PRACTICUM PLACEMENT: □International □National □Regional □Local
PRINTED NAME AND SIGNATURE DATE
City/Town:
Step 5. Proceed to practicum adviser.
Practicum Adviser _____________________________ _______ ___________________________
PRINTED NAME AND SIGNATURE DATE

YOU CAN START YOUR OJT. Training Establishment Address Contact No.
AFTER OJT
Step 1. Submit photocopies of DTR & Certificate of completion to
the Registrar’s Office.
Registrar ______________________________ ________
PRINTED NAME AND SIGNATURE DATE
Step 2. Submit Practicum Evaluation to practicum adviser. Duration of Training (hours): _________ Start Date: _________________ End Date: _________________
Practicum Adviser ______________________________ ________
PRINTED NAME AND SIGNATURE DATE
III. CONTACT DETAILS Contact person in case of emergency
STEP 3. Submit the ff. hard & scanned copies to Practicum
Name: _____________________________________ Relationship: __________________________
Coordinator
⃝ Practicum Evaluation* ⃝ Copy of Certificate of completion
Mobile No.: ______________________________ Telephone No.: __________________________
⃝ Copy of DTR ⃝ OJT Documentation * Home Address: ____________________________________________________________________
Practicum Coordinator ______________________________ ________ Company Address: _________________________________________________________________
NOTE: All documents mustPRINTED
be sentNAME AND SIGNATURE DATE
to lsupracticumoffice@lsu.edu.ph