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Republic of the Philippines

ZAMBOANGA STATE COLLEGE OF MARINE SCIENCES AND TECHNOLOGY


Fort Pilar, Zamboanga City
Tel. No.: (062) 991-0643 Telefax (062) 991-0777 website: http//www.zscmst.edu.ph

COLLEGE OF EDUCATION AND LIBERAL ARTS


TEACHING INTERNSHIP EXIT SURVEY FORM
A. RESPONDENT’S PROFILE

Instructions: Kindly supply the data asked for and mark the appropriate information on the blank provided for.
Your answers will be highly appreciated.

Name: ____________________________________________________________________________
Surname First Name Maiden/Middle Name Suffix

Name of Cooperating School: ________________________________________________________

Address: ___________________________________________________________________________

Type of School: Private Sectarian Private Non-sectarian Public

Age: 19 21 23
20 22 24 over 24

Year Graduated from HS: SY________________

Grade Level Taught: Pre-school Junior HS


Elementary SHS SPED

Subjects Taught: Filipino Math


English Science Araling Panlipunan

Number of Hours Rendered: 100 Hours 150 hours 200 hours more than 200

B. PRACTICUM EXPERIENCES

Instructions: The purpose of this evaluation is to gain feedback regarding the quality of your teaching internship.
The concerns noted will initiate corrective actions to improve the quality of the teaching internship. Your honest
answers to this questionnaire will be highly appreciated. Please tick and rate the items using the given scale:
5- Excellent 4-Very 3-Good 2-Fair 1-Needs Improvement
5 4 3 2 1
Orientation Activities
1. Orientation of the student interns by the practicum Supervisor on Teaching
Internship.
2. Orientation of the student interns with the Cooperating Principal
3. Orientation of the Student Interns by the Cooperating Teacher
4. Familiarization of the Student Interns with school Facilities/Equipment
5. Orientation of the School Rules and Policies
6. Familiarization of Required Internship Forms
7. Practicum Experiences of the Students Interns
8. Consultation time with the Cooperating Teachers
9. Assistance in writing Learning Plans
10. Providing Feedbacks on the Student Intern’s Competencies
11. Meeting with the Cooperating Teachers on scheduled basis
12. Giving Instructions on classroom routines
13. Providing assistance in making instructional materials
14. Giving instructions in checking papers and other assigned tasks
Rapport with School Community
15. Rapport with school Administrators/Principal
16. Rapport with Cooperating Teachers
17. Rapport with Students
18. Rapport with Parents
19. Support with Non-teaching personnel
Practicum Site
20. Accessibility of the Practicum Site
21. Safety and security of the practicum site
22. Quality of Ancillary Services
Activities of the Student
23. Preparation of Daily Lesson Plans
24. Participation in School Activities in the practicum site
25. Preparation of Instructional Materials
26. Execution of Demonstration Learning Plans
27. Assistance in Classroom Routines
28. Structuring of Bulletin Boards
29. Preparation of Seatworks
30. Preparation of Quizzes

Suggestions and Recommendations:


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Issues and Concerns Encountered:

__________________________________________________________________________________
__________________________________________________________________________________
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_____________________
Date and Signature

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