PRACTICUM INTERNSHIP AGREEMENT AND INSTRUCTION FORM

Start Date: September 12, 2022 End Date: January 2023

# of weeks: 17 # of Hours per Week: 40
Total Hours: 600

Student Information
Name: Erica A. Relampagos Email: ericarelampagos7@gmail.com
Address: Poblacion North, Piñan Zamboanga del Norte
Telephone :( Home) N/A Site: N/A

PRACTICUM/INTERNSHIP Job Description:

1. Organization Name: PHILIPPINE STATISTICS AUTHORITY (PSA), serves as the
central statistics authority of the Philippine government on primary data collection.
2. Provide your PRACTICUM?INTERSHIP Supervisor’s name and contact information
Supervisor’s Name: Sesenia C. Belorio Title: Supervising Statistical Specialist
Phone: N/A Fax: N/A Supervisor’s Email: N/A
Address: Arellano Extension, Miputak Dipolog City
3. PRACTICUM?INTERSHIP job title:
On the – Job – Training
4. What will be your typical schedule?
a. Monday – Friday
b. 8:00am – 5:00pm
5. What will be your duties and responsibilities?
a. Encoding Collective Data
b. Creating Power Point Presentation
c. Info Graphic
6. Learning Objectives
a. Developing Skills
b. Develop Knowledge
c. Developing Competencies
d. I will hand in my final report by January 26, 2023 to my SVC
PRACTICUM/INTERNSHIP advisor via hard copy.

Student’s Signature: _______________________________ Date: ____________________

I acknowledge that the above information is accurate and valid and I agree to assume supervisory
responsibility for the PRACTICUM/INTERNSHIP experience of the students as described.

Site Supervisor’s Signature: _________________________ Date: __________________

PRACTICUM/INTERNSHIP Advisor’s Signature and Date: _________________________