FORM 6- EMPLOYER INFORMATION FORM

BUKIDNON STATE UNIVERSITY

Malybalay City, Bukidnon
College of Business
Government Affairs Department
Public Administration

EMPLOYER INFORMATION FORM

AGENCY/ ORGANIZATION INFORMATION
Agency/ Organization Name: Date
BUKIDNON ENVIRONMENTAL AND NATURAL RESOURCES
Mailing Address:

City Province

Mr. Mrs. First Name Last Name

Ms.
Job Title:

Office # Cell Ph # (optional)

E-mail: Website Address: (if available)

STUDENT INTERN DETAILS

STUDENT INTERN’S Internship location (if Estimated Weekly work
NAME: different from above) hours:

Student will be an intern with us 1st 2nd Summer

for the following semester:

Intern Qualifications: Student will be using the following skills to complete the
internship.

Written and verbal communication skills Organizational skills Presentation

skills
Technical skills (pls. specify)
FORM 7- STUDENT REPORT AND GOALS & LEARNING OBJECTIVES AGREEMENT

STUDENT INFORMATION
Complete ALL sections and submit to Internship Faculty Coordinator. (Please type or
print clearly)

Date: ID No. : Gender __________

Student’s Last First Middle

Name
Permanent
Address
City Address
Cell Number Birthdate
E-mail Ad (month, date,
year)

INTERNSHIP INFORMATION
(Please type or print clearly)

Agency Name:
__________________________________________________________________

Supervisor Contact

Name: Phone No.

Email Add: Fax No.
Website Address:
Address

Xxxxx -------------------------------------------------------------------------- xxxxx

GOALS AND LEARNING OBJECTIVES AGREEMENT

GOALS

LEARNING OBJECTIVES you aim to achieve

1.
2.
3.
4.
5.
FORM 8 - SAMPLE CERTIFICATION OF ACCEPTANCE

(Date)

Dr. Lorenzo B. Dinlayan, III

Chairperson, Government Affairs Department/
Faculty Internship Coordinator
College of Business
Bukidnon State University

Dear Dr. Dinlayan:

This confirms the acceptance of the following student/s as intern/s in our office.

Name of Intern:
Internship Period:
Unit / Division:
Expected Tasks/ Responsibilities:
Name of Supervisor:
Position and Contact Details of Supervisor:

As internship partner of the Government Affairs Department, College of Business,

Bukidnon State University, we agree to abide by Internship Guidelines:

1. The internship program shall be for a minimum of 360 hours under

academic and professional supervision. The internship period shall begin on
January , 2017 and end no later than April ,2017.
2. The office shall ensure safe working condition on the intern.
3. The office shall allow the internship coordinator to observe the intern at
work and discuss with supervisor/mentor issues about the intern or the
internship program.
4. Upon completion of the internship, the office shall submit to GAD-Public
Administration (a) a Certificate of Completion of Work Hours; (b) an Intern
Evaluation Form; and (c) the intern grade/s

We completely understand the internship guidelines. Any discussion pertaining to

the unbecoming performance of the intern, we will immediately inform your office in
writing.

(Name and Signature of the Office Head)

(Contact Details)
 FORM 9- MEMORANDUM OF UNDERSTANDING

Know all men by these presents:

This contract is entered into by and between the Government Affairs Department, College of
Business, Bukidnon State University represented by Dr. Lorenzo B. Dinlayan, III,
Chairperson, Government Affairs Department, of legal age, married, Filipino and resident of
Malaybalay City herein after called the PARTY OF THE FIRST PART and City/Municipality of
_________________, Bukidnon represented by ___________, likewise of legal age, married,
Filipino, and a resident of ___________________________________________, Bukidnon hereinafter
called the PARTY OF THE SECOND PART.

That the PARTY OF THE FIRST PART is an educational institution and requiring its students
to do practicum as a part of their curriculum while the PARTY OF THE SECOND PART in
which the latter accepts, under the following terms and conditions:

For the Student-Intern

1. Must have completed 60 units in Public Administration subjects.
2. Need to complete the 14 weeks or 400 hours.
3. Wearing of practicum uniform and ID during office hours must be observed.
4. Observe proper behavior and office decorum.
5. Should report regularly and observe office hours.
6. Use DTR (Daily Time Record)/Bundy Card.
7. Should comply requirements given by the agency/office.
8. Submit Narrative Report.
9. Practicum is part of the curriculum.
10. In case of failure to comply the OJT policies, the student is disqualified to OJT.

For the Agency:

1. Evaluate the student’s performance by giving a grade ranging from 1.0-3.0.
2. Sign the student DTR and narrative reports.
3. Assign work to students related to their field of discipline.
4. Require students to follow office rules/ policies and standard operating procedures.
5. Refer/ confer with the practicum adviser on problems regarding practicum students.

IN WITNESS WHEREOF, we have hereunto set our hands this _________day of ______, 20__at
Malaybalay City.

Government Affairs Department City/Municipality of________

College of Business Bukidnon

By: By:
DR. LORENZO B. DINLAYAN, III
Party of the first Part
Res. Certificate No._______
Issued at_________________
Issued on________________

Witnessed by: Witnessed by:

______________________________ ______________________________
Name, signature and date signed Name, signature and date signed

_____________________________ _____________________________
Position/ Designation Position/ Designation
 FORM 10- SELF EVALUATION
BUKIDNON STATE UNIVERSITY
Malaybalay City Bukidnon
College of Business
Government Affairs Department

SELF-EVALUATION

Student’s Name Phone No.

Supervisor’s Name Phone No.

Address
Agency Name

Internship Period: From __________ To ___________

SELF EVALUATION: As mentioned before, the objective of this internship is to provide you as a student with
meaningful work assignments in a professional career field. Please use the following scale to rate your work
experience:
1= Unsatisfactory 2= Marginal 3= Average 4= Above Average 5= Outstanding

Ability to Learn: Clarity of directions from supervisor and other key persons.
1 2 3 4 5
Quality of Work: Quality of assignments given to you for this internship, and did you meet the objectives.
1 2 3 4 5
Quantity of Work: Volume of Work assigned to you.
1 2 3 4 5
Communication: Ease of communication with supervisor and other key person
1 2 3 4 5
Relationship with others: Acceptance by co-workers at the internship site
1 2 3 4 5 NA
Attitude-application to work: how interesting and challenging was this internship?
1 2 3 4 5
Planning & Dependability: how effective were you in planning & coordinating your work, even in the absence
of direct supervision
1 2 3 4 5
Judgment: opportunity to analyze problems and make appropriate recommendations
1 2 3 4 5 NA
Attendance: your attendance to the established work schedule, or in keeping regular communication with key
contact.
1 2 3 4 5
Overall Performance: overall rating of your internship experience

1.0 1.25 1.50 1.75 2.0 2.25 2.50 2.75 3.0

Was this a Fulfilling internship experience and one that will help with your career preparation? ___
Do you plan to change your education curriculum (major or electives) as a result of your work experience?___
Yes ____ No How?

Would you be willing to recommend this internship program to others?___ Why?

If this was a paid internship, how much were your paid per day?

Student’s Signature

Date
 FORM 11- AGENCY EVALUATION

BUKIDNON STATE UNIVERSITY

Malaybalay City, Bukidnon
College of Business
Government Affairs Department

Name of Organization
Supervisor’s Name Phone
Intern’s Name
Internship Period (14-week period) From ______________ To ___________________

STUDENT EVALUATION: Please rate your intern OBJECTIVELY in each of the areas below using the following rating

scale: 1 = Unsatisfactory 2 = marginal 3= average 4 = Above Average 5 = Outstanding NA = Not applicable

Ability to Learn: How effective was the intern in understanding and following general instructions?
1 2 3 4 5
Technical aptitude: How effective was the intern in understanding the technical aspects of their field, and relating that
knowledge to their job?
1 2 3 4 5 NA
Quality of Work: quality of assigned work that the intern provided to you, and did the intern meet the objectives?
1 2 3 4 5 Yes No
Communication: How effective was the intern in communicating both orally and in writing?
1 2 3 4 5
Relationship with others: How well did the intern work with other employees in your firm?
1 2 3 4 5 NA
Attitude-Application to work: How enthusiastic was the intern with this internship project?
1 2 3 4 5
Planning & Dependability : how effective was the intern in planning and coordinating his/her work, and dependable in
working steadily, even in the absence of direct supervision
1 2 3 4 5
Judgment: How well did the intern perform in analyzing problems and making appropriate recommendations? or in
formulating and advancing new plans, ideas, projects?
1 2 3 4 5 NA
Attendance: Rate the intern’s attendance to the established work schedule?
1 2 3 4 5
Promptness in reporting for work:
1 2 3 4 5 NA (virtual
internship)
Did the Student intern complete the required number of internship hours? (i.e., 320 hrs)
Yes No Comment:
Overall Performance: How well did the intern perform on this internship?
1.0 1.25 1.50 1.75 2.0 2.25 2.50 2.75 3.0

Has your organization previously used student interns from Bukidnon State University? ____
Would you be interested in continuing to participate in our internship program? _____
If yes, please indicate the semester you would like to recruit another intern?
1st sem 2nd sem Summer
Was there an opportunity to offer the student a full or part time job?
Yes No starting salary _______________
Would you be willing to recommend this type of program to other Yes No
Do you have any constructive criticism to offer regarding this student intern? Yes No
Please specify

Supervisor’s Signature / date signed

Thank you for completing this evaluation and participating in our internship program1 Please give to your intern in
sealed envelopes: one copy to Faculty Internship Coordinator.
FORM 12- SAMPLE DAILY TIME RECORD

DAILY TIME RECORD

Name
For the month of 20
Official hours for arrival and departure
Regular Day:
Day A M P M Under
time
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31

I CERTIFY on my honor that the above is

true and correct report of the hours of worked/
performed, record of which was make daily at
the time of arrival and departure from office.

Signature

Verified as to the prescribed office hours

In- charge
FORM 13 - CERTIFICATION OF COMPLETION OF INTERNSHIP

Republic of the Philippines

Province of Bukidnon
Municipality/City of _______________

OFFICE OF THE ____________________

CERTIFICATION

This is to certify that _________________, a Bachelor of Public

Administration student of Bukidnon State University, Malaybalay City has
rendered services in this office as a student apprentice under the On-the-Job
Training Program from the period________________, 2017 to______________, 2017
with a total of 360 hours.

Given this _______ day of __________, 2017 at

________________________.

__________________________
Position
FORM 14- WEEKLY JOURNAL

Name of Intern ____________________________

Agency/Address ____________________________

WEEK DATES ACTIVITIES ASSIGNMENT/ ACCOMPLISHMENT

Week 1

Week 2

Week 3

Week 4

Week 5

Week 6

Week 7

Week 8

Week 9

Week
10
Week
11
Week
12
Week
13
Week
14
Week
15
Week
16
Week
17
Week
18
Week
19
Week
20
FORM 15 – SAMPLE THANK YOU LETTER

Date

Supervisor’s Name, Title

Organization’s Name
Address

Sir/Madame:

As I conclude this internship, I want to let you know that it’s been a pleasure to
work with you and others at _______________________, your leadership, patience,
and enthusiasm made my internship experience a positive one. You’ve given me a
great opportunity to use my formal education in a real-world application,

I really appreciate the time you’ve taken to train and teach me new skills. Through
this internship I’ve also increased my knowledge in this area. In exchange, I hope
I’ve been a positive contribution to ___________________________.

During this last week I will be finalizing all details to my internship project. If there
is anything else I can assist you with before my last day here, please let me know.
Once again, thank you for this wonderful internship experience.

Very sincerely,

Intern’s Name
Address
Phone number
FORM 16- SURVEY QUESTIONAIRE

BUKIDNON STATE UNIVERSITY

Malaybalay City, Bukidnon
College of Business
Government Affairs Department

PROBLEMS ENCOUNTERED BY PUBLIC ADMINISTRATION STUDENTS

Directions:

1. Rank the problems (A-F) according to scale 1-6 with 1 as less encountered and 6
as most encountered.

2. Check the sub problems which you encountered during your practicum.

RANK PROBLEM

[1] A. FINANCIAL [ ]
1. Meal Allowance [ ]
2. Uniform for Practicum [ ]
3. Rental for Boarding House [ ]

[2] B. HUMAN RELATIONS [ ]

1. Relationship with Peers [ ]
2. Relationship with Employer [ ]
3. Relationship with Adviser [ ]

[3] C. REPORTS [ ]
1. Accessibility to Transportation [ ]
2. Assigned station is far from the campus [ ]

[4] E. COMPUTER SKILLS [ ]

1. Difficulty in making a report [ ]
2. Difficulty in meeting the deadline [ ]

[5] F. NATURE OF WORK/ASSIGNMENT [ ]

1. Not related to major subject [ ]
2. Assigned works are beyond their capacity to do [ ]

G. OTHER PROBLEMS
FORM 17- GRADE SHEET

BUKIDNON STATE UNIVERSITY

Malaybalay City, Bukidnon
College of Business
Government Affairs Department

GRADE SHEET

FULL NAME ATTENDANCE PERFORMANCE FINAL GRADE REMARKS

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

General Comments for the intern/s

__________________________________________________________________________________________
__________________________________________________________________________________________
___________________________________________________________________________

GRADE DESCRIPTION

1.00 - Excellent
1.25 - Superior Rated by:
1.50 - Very Good
1.75 - Good
2.00 - Highly Satisfactory _____________________________
2.25 - Satisfactory Name
2.50 - Batter than Average
2.75 - Average __________________________
3.00 - Passed Position

__________________________
Office/Agency

__________________________
Date
FORM 18 - SAMPLE COVER PAGE FOR THE NARRATIVE REPORT

College Of Business
Government Affairs Department
Public Administration

(name/s of intern/s)

submitted in fulfillment of the requirements for the course

Public Administration 116- Internship in Government Administration

Bukidnon State University

(Date Submitted)