Republic of the Philippines

Mindanao State University

Maigo School of Arts and Trades
Maigo, Lanao del Norte
(Tel. No. (063) 227-4200 ; Cell No. 09454931275)

REQUIREMENTS FOR WORK IMMERSION

Documents
Remarks

1. Application Letter ____________________

2. Parent’s/Guardian’s Waiver ____________________
3. Medical Certificate ____________________
4. Barangay Clearance ____________________
5. Police/PNP Clearance ____________________
6. Bio-Data ____________________
7. Work Immersion Performance Appraisal
____________________
7. Daily Time Record ____________________
8. Copy of Certification of Completion ____________________
9. Copy of Work Immersion Acceptance Form ____________________
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Name of Trainee : J.r Dean C. Dalo_________________________________

Address : Purok – 5, Labuay, Maigo, Lanao del Norte

Contact Number : 09555484548

Track : Technical Vocational and Livelihood_________________

Strand : Automotive Servicing_________________________________

Cleared for Work Immersion:

RODEL C. APAO
Work Immersion Teacher

NOTED:

EMILY G. CABARDO
Work Immersion Program Supervisor

Recommending Approval: Approved:

CATALINA A. REQUINA MACABANGKIT P. ATI,

DPA
Secondary Department Chairperson MSUS EVP/MSU-MSAT Campus
Head