FACULTY OF ENGINEERING,

ARCHITECTURE & INFORMATION

TECHNOLOGY

CERTIFICATE OF ENGINEERING PROFESSIONAL PRACTICE

(This form cannot be used as a reference)
SECTION A: TO BE COMPLETED BY STUDENT:
Name Student Number
Program Graduation Date Semester, Year
Major ⃝ Single ⃝ Extended ⃝ Dual
Name of Company
Address of Company
Period of Placement From: DD/MM/YYYY To: DD/MM/YYYY No. of Days Completed Days
Summary of Experience

Signature Date
SECTION B: TO BE COMPLETED BY PLACEMENT PROVIDER:
Please verify total number of days of placement Days
Number of days spent assisting or under the immediate direction of a professional engineer Days
Supervisor's remarks on student's performance (can be included in an official statement from company)

Signature Position Phone

Print Name Date Email
SECTION C: TO BE COMPLETED BY SCHOOL:
Is report satisfactory? (If No - Please supply comments) Yes No

Recommended credit towards 60 days required in an engineering environment and Days

Recommended credit towards minimum 30 days under supervision of an engineer Days
Print Name Initial Date
The School is requested to return the completed form to the EAIT Faculty Office
Upon finalisation: Milestone Completed Or ____ / ____ Days Remaining

Upon submission please ensure: OFFICE USE ONLY

1) The company has completed both lines for the days of your placement in Section B; No. of Days Checked
2) For placements that occur outside of normal hours, or include public holidays/weekends, Supporting Document Tick if Applicable
a letter from the placement provider confirming the hours or timesheets must be attached. Initial

March, 2016