J.H.

CERILLES STATE COLLEGE

School of Engineering and Technology

INTERNSHIP PROGRAM
AGREEMENT AND CONSENT FORM

This is to certify that we have read and understood the foregoing Manual of the
School of Engineering and Technology Internship Program with its rules and regulations. We
hereby agree to abide by them.
In this connection, I, (name of Intern)
will submit myself to any and all disciplinary actions that may be imposed upon me and to
assure the Program of my commitment.
I, (name of Parent/guardian), hereby give
my consent, to the admission of my son/daughter/ward to the BSIT Internship (On-The-Job
Training) Program and hereby accept the rules and regulations of the Program as presented in
the Manual.
We hereby hold the College free from any liability that may arise, monetary or
otherwise, for any and all acts or commissions and/or omissions that may cause damage or
prejudice to any person during the entire period of my Internship with the assigned
Companies/Agencies.

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Intern’s Signature

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Intern’s Printed Name

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Date

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Parent’s/Guardian’s Signature

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Parent’s/Guardian Printed Name

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Date