2020 Level 2

Recognition for
SAMAR STATE UNIVERSITY Proficiency In
Quality Management
Arteche Blvd., Catbalogan City, Philippines 6700
College of Education | Student Teaching Office

STUDENT PLEDGE AND COMMITMENT

I, __________________________________________________, ______ years of age, and a student in the undergraduate

program of ___________________________________________________ in Samar State University, Catbalogan City, Samar,
bears witness and affirms the following:

1. I promise to obey and abide by all the rules and regulations promulgated and to be enforced in by
Samar State University, its officials and other duly constituted authorities;
2. I promise to adhere to the existing rules and regulations of the agency/industry where I am accepted
for Field Study observation and/or internship including the proper use of tools, facilities,
instruments, machines, and equipment;
3. I promise to perform the task and activities indicated in the FS/ internship plan with utmost
commitment to work of responsible individuals;
4. I promise to maintain utmost confidentiality when and where appropriate, of all the data, business
or trade secret during and after the internship period as such information, is not within the public
domain and is indicated and understood to be confidential;
5. I promise to perform the task and activities to the best of my ability and to engage in responsible
and ethical behavior; and
6. I have and fully understood the contents of this student’s pledge and commitment to my full
knowledge, affixing my signature hereon freely and voluntarily.

IN WITNESS WHEREOF, I hereby sign my name this ______ day of _________________________, 2022 at Catbalogan
City, Samar, Philippines.

___________________________________________
Name and Signature of the Student

PARENT’S OR GUARDIAN’S AGREEMENT

I, ________________________________________________, of legal age, single/married and a resident of

_____________________________________________________________ whose signature appear below, have read and
understood the contents of the foregoing pledge and agree with and concur on the same and without any
qualifications or mental reservation.

I hereby certify to the correctness and accuracy of the above statements.

________________________________ ___________________________________________________
Date Name and Signature of Parent/Guardian

SUBSCRIBED AND SWORN TO ME this _______ day of ___________________________, 2022, affiant exhibiting to me
his/her Residence Certificate NO. ________________________________ Issued at
___________________________________________________ on _________________________________________________.

________________________________________
Legal Officer

Website: www.ssu.edu.ph
Contact us: (055) 530-0629 | info@ssu.edu.ph 1st Philippine Higher Education Internationalization Awardee (2021)
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