Lyceum of the Philippines University

Cavite Campus

COLLEGE OF ENGINEERING, COMPUTER STUDIES AND ARCHITECTURE

Request to Credit Alternative Learning (for Practicum/Internship)

Period of Enrollment ☐ Semester _________ ☐ Special Term

Please put a ✔mark AY 20_____ - 20_____
Printed Name (Lastname, Given Name)

Year / Level and Course/Program

This is to request that the f ollowing Alternative Learning Activities that I have attended, completed and
complied with, be credited to my practicum / internship training hours:

ALTERNATIVE LEARNING DATE / PERIOD REQUIRED ATTACHMENT CREDIT

ACTIVITIES OF ACTIVITY HOUR/S
1. Fun Run ☐ Certif icate of Participation

2. Participation in Competition/s
AS PARTICIPANT ☐ Certif icate/s of Participation
- Regional
- National ☐ Certif icate/s of Participation

- International ☐ Certif icate/s of Participation

AS WINNER ☐ Certif icate/s of Recognition

- Regional
- National ☐ Certif icate/s of Recognition

- International ☐ Certif icate/s of Recognition

3. Employment ☐ Approved Request Letter

☐ Certif icate of employment
☐ Copy of Income Tax Return (ITR)
4. Business ownership ☐ Approved Request Letter
☐ Business registration
☐ Business Permit
☐ Business Tax Identif ication Number
(TIN)
☐ Others

TOTAL OF CREDIT HOURS

Requested by:

STUDENT APPLICANT
Signature over Printed Name / Date

Evaluated by: Validated / Endorsed by: Approved by / Date:

Dr. ARNEL M. AVELINO

INTERNSHIP COORDINATOR PROGRAM CHAIR / DEAN
Signature over Printed Name / Date COORDINATOR
Signature over Printed Name / Date

CEA-TPI-01.003 (Jul 01 2023)