SIWES FORM D
LANDMARK UNIVERSITY
STUDENT INDUSTRIAL WORK EXPERIENCE
SCHEME (SIWES) UNIT
ASSESMENT OF INDUSTRIAL TRAINING PROGRAMME FORM
PART A (To be completed by the Student)
1. (a) Full Name:
…………………………………………………………………………………..........
(b) Matriculation Number
…………………………………………………………………………………………
(c) Programme: ………………………………….………………………………………
(d) Level ……………………………………………………………………
2. (a) Name & Address of the Establishment of Attachment:
………………………………………………………………………………………………
……………………………………………………………………………………………………
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(b) The Department/Section:
……………………………………………………………………………………………………
………………………………………
(c) Period of Attachment: From: ……………………………… To: ……………………………….
Number of Weeks: ………………………………………
3. Total Allowance received by Student: N ……………………………………………...K
4. Brief outline of experience/relevance of training provided: …………….............................................
……………………………………………………………………………………………………………
5. (a) Where were you attached last? (if applicable):
,………………………………………………………………………………………………………
………………......................…………………………………………………………………………
…………………………………………………………………………………………………………
…………………………………..
(b) Total number of weeks engaged on industrial attachment: ……………………………………
Signature of Student: ……………………………….. Date: …………………
PART B (To be completed by the Employer)
6. Do you agree with the student’s comments in items 3 & 4 in Part A? YES / NO
If No, please comment:
…………………………………………………………………………………………………………………
………………………………………………………………………..
State total amount paid to student as training allowance N ….……………………………………K
In words………………………….………………………………………………………………………
7. Please assess the student’s overall performance by ticking the appropriate box provided
EXCELLENT VERY GOOD GOOD VERYSATISFATORY
POOR
8. Will you accept the student in any future attachment? YES / NO
If No, please comment: ………………………………………………………………………………..
……………………………………………………………………………………………………………….
9. Is your Company/Establishment in a position to offer this student a job in future? ………………..
10. Will your company want to have IT students from the University subsequently? ............................
11. Name of Reporting Officer: …………………………………………………………………………
Designation/Rank: ……………………………………………………………………………………
Signature/Stamp:……………………………………………Date:……………………………………
N.B. Forms duly completed by employers should be returned to student for submission to the University’s
SIWES Office under seal:
PART C (To be completed by the Institution)
12. Indicate number of visits:
………………………………………………………………………………………………………………
………………………………………………………...
13. Give your assessment of facilities provided by Company during visit(s) by ticking:
STANDARD ADEQUATE RELEVANT NOT RELEVANT
14. Give your impression of the student’s involvement in training: FULLY/PARTIALLY
……………………………………………………………………………………………….………
………………..………………………………………………………………………………………
15. Assessment of student’s performance (Grading “A, B, C, or D” has to be stated)…………………
Full Name of Supervisor …………………………………………………………………………
Status: ……………………………………………………………
Department/Discipline: ………………………………………………………………………………….
Signature/Stamp:……………………………………………………………………………………………
……………………………..…..Date:…………………………………………………………….
