COLLEGE OF ARTS, SCIENCES AND EDUCATION

INTERNSHIP INFORMATION SHEET

Name of Student-Trainee:

Program:

Student Number:

School e-mail Address:

Personal e-mail Address:

Address during Internship:

Contact number:

Name of Internship Agency:

Address of Internship Agency:

e-mail and homepage of Internship Agency:

Contact number of Internship Agency:

Name of Agency Supervisor/Representative:

Designation of Agency
Supervisor/Representative:

Duration of Internship Agreement (Month-

Year):

________________________________

Name and Signature of Student Trainee

Date signed: _____________________

Brgy. Paciano Rizal, Calamba City, Laguna, 4027 Philippines  Tel. No.: (049) 834-1159
www.perpetualdalta.edu.ph
Calamba Campus