EKITI STATE UNIVERSITY, ADO-EKITI

EKITI STATE NIGERIA

STUDENTS INDUSTRIAL WORK EXPERIENCE SCHEME (SIWES)

ASSUMPTION OF INDUSTRIAL TRAINING FORM

1. TO BE FILLED BY STUDENT
Name of Student: (Surname First)…………………………………………………………………………………………….

Matriculation Number:……………………………………. Phone No: ………………………………………………….

Email: …………………………………………………………………………………………………………………………………………..

Department: ……………………………………………………………………………………….

Faculty: ………………………………………………………………………………………

Date of Assumption:…………………………………

Name and Address of Establishment (including phone and e-mail):

………………………………………………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………………………….

Student’s Signature:

2. TO BE FILLED BY OFFICER IN CHARGE OF STUDENT INDUSTRIAL TRAINING IN THE

ESTABLISHMENT

Name:

Signature and Establishment Seal/Stamp:

Date:

NB:
Student should fill all the required information, scan the COMPLETED FORM and upload it to SIWES
WEBLINK within the FIRST THREE WEEKS OF ASSUMPTION OF DUTY. The advance scanned copy should be
uploaded to the website (https://forms.gle/2oK9BK8wzcHRyD1S9) to facilitate the smooth process of
supervision. Please note that the file size should not be more than 1MB and in JPEG or PDF. Your personal
email should be included as requested in the Google Form for a receipt of the completed form. Your email
can only be used once. For more enquiries: SMS & WhatsApp ONLY on 08067498815

Dr. O. Adetan
SIWES Coordinator