UNIVERSITY OF
NEGROS OCCIDENTAL–RECOLETOS, INCORPORATED
COLLEGE OF ENGINEERING
#51 Lizares Ave., Bacolod City, Philippines 6100 · www.uno-r.edu.ph ·
[email protected] · 0344332449 loc 107
STUDENT INTERNSHIP INFORMATION SHEET 1X1 PICTURE
Student Trainee Information:
Name of Student:
(Family Name) (Given Name) (Middle Name)
Course: Year:
Address:
Contact Number: E-mail Address:
Mother’s Name: Contact Number:
Father’s Name: Contact Number:
Guardian’s Name: Contact Number:
Host Training Establishment Information:
Name of Company/HTE:
Address: Contact Number:
Department in the Company assigned:
Name of Immediate Supervisor:
Contact number: E-mail Address:
Inclusive Date of Internship: from to
Name of Person to contact in case of Emergency:
Relationship to the student trainee:
Contact Numbers:
Student’s Signature overprinted name Faculty OJT Adviser’s
Signature overprinted name
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