L-WIF 4

Republic of the Philippines

Department of Education
Region III- Central Luzon
Schools Division of Bulacan
SAN RAFAEL NATIONAL TRADE SCHOOL
SENIOR HIGH SCHOOL DEPARTMENT
Caingin, San Rafael, Bulacan
Tel. No. 044-816-7789

WORK IMMERSION FORM 4 (L-WIF4)

ACCOMPLISHMENT REPORT
SY ___________

Name of Learner: Haidee S. Villanueva LRN :105115060148 Section: 12-Phoenix Track/Strand/Specialization :Academic /STEM Venue: __________________
(To be accomplished by the
industry supervisor) Signatures
NO. OF STATUS
DATE TASKS WORKING
HOURS REMARKS Work Work
Not
Completed Learner Immersion Immersion
Completed
Supervisor Teacher
 L-WIF 4

NO. OF (To be accomplished by the

DATE WORKING STATUS industry supervisor) Signatures
TASKS
HOURS
Work Work
Not
Completed REMARKS Learner Immersion Immersion
Completed
Supervisor Teacher

TOTAL NUMBER OF HOURS

Important: (To be accomplished by work immersion supervisor)

Additional feedback, comment or suggestions regarding the performance/accomplishments of the learners during work immersion.

_____________________________________________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________
Prepared:

________________________________________
Learner’s Signature Over Printed Name

Attested:

_______________________________________ ______ ________________________________________

Signature Over Printed Name (Work Immersion Teacher) Signature Over Printed Name (Industry Supervisor)

Noted:

LEODORA G. MENDOZA
Principal III