ANNEX C.

Prescribed Template for the List of Tasks/Activities to be done during Work Immersion

Name of Student Grade and Section

School Immersion Site
Track Strand/Specialization
Duration of Work Immersion

School Partnerships Focal Person Contact Number

Work Immersion Teacher Contact Number

LIST OF TASKS/ACTIVITIES

Competencies Tasks/Activities Time Allotment Actual Schedule Remarks

Students shall not be given other activities outside of those previously agreed upon, which are anchored on the
stated competencies.

Certified true and correct:

_________________________________ ________________________________
Student’s Signature Over Printed Name Parent’s Signature Over Printed Name

_________________________________ _________________________________
Work Immersion Teacher’s Signature Industry Supervisor’s Signature
Over Printed Name Over Printed Name