FM-AA-INT-15

Rev. 0
03-Oct-2017

INTERNSHIP RELEASE FORM

PANGASINAN STATE UNIVERSITY

_________________________
Date

_________________________

_________________________

_________________________

Course:

Major:

Upon completion and submission of all your required documents for your Internship / Practicum activity, you
are hereby released to undergo 400 hours Internship / Practicum at

Cooperating Company/Agency/Firm: ____________________________________________________

Company/Agency/Firm Address: ________________________________________________________

From ______________, _______ to ______________, _______.

Please be guided with the school and company Internship / Practicum policies and guidelines throughout the
duration of your Internship / Practicum Activity

Internship / Practicum Subject Instructor PROF. FRANCIS LAZO

Campus Internship Coordinator

Noted:

ARMANDO D. JUNIO, Ph. D

Campus Executive Director