UP College of Mass Communication

Department of Broadcast Communication

CONSENT FORM: BC 198 (Internship Program)

I, _______________________________________________, do hereby give my consent to the

Department of Broadcast Communication to use the information and observations I have made
in my Participation-Observation Protocol for any academic research or study of the Department
to improve and enrich its internship program.

_________________________
PRINT NAME AND SIGN ABOVE

DATE: ___________________

NOTED:

__________________________
BC 198 Faculty
(PRINT NAME AND SIGN ABOVE)

DATE: _____________________