DALUBHASAAN NG LUNGSOD NG LUCENA

(Formerly City College of Lucena)

Isabang, Lucena City
Bachelor of Science in Social Work Program

STUDENT’S CHECKLIST OF REQUIREMENTS

Field Instruction 1
1st Semester, AY 2020-2021

Name of Affiliate Mary Ann O. Ostonal Sex Female

Contact Number 09306250035 Date of birth November 20, 1995
Placement Area Dalubhasaan ng Lungsod ng Lucena Place of Lucena City
birth
Agency Supervisor Ms. Flordelisa N. Escultura Religion Roman Catholic
School Field Mr. Cesar Jose Email maryannocsalesostonal@gmail.com
Instructor address

A. Upon Enrolment (all duly signed)

NO. PARTICULARS Date of Submission

1 ☐ Placement Preference Form

2 ☐ FI Letter of Application At the start of the
3 ☐ Resume semester
4 ☐ Autobiography
5 ☐ Parent’s/Guardian’s Consent (handwritten by parent/guardian and
notarized)
6 ☐ Medical Certificate (note: medical examinations for Chest X-ray, blood chem,
urinalysis, pregnancy test for female, and general health condition should be done)
7 ☐ Insurance (validity should cover the duration of Field practice)
8 ☐ School Waiver
9 ☐ Learning Agreement
10 ☐ Work plan (General)
11 ☐ FI Terms of Reference

B. During Field Placement (all duly signed)

1 ☐ Time Sheet (completion of 500 hours of field practice) Monthly

2 ☐ Process Recording (weekly) Prior to supervision
3 ☐ Daily time record Daily
4 ☐ General Work plan (from start and end of placement) First week of placement
period
5 ☐ Weekly Work plan Star of the Week
6 ☐ Minutes of the meeting After all meetings
7 ☐ 3 Case studies (FI 1) Finals
8 ☐ 1 Group Study (FI 1) Finals
9 ☐ 1 Community Study (FI 2) Finals
10 ☐ Integrative paper with Photo Documentation Finals
11 Portfolio

Attendance and submission of required documents:

1 ☐ Regular supervision (school and/or agency)

2 ☐ Trialogues (Entry, Midplacement, Final) (as scheduled)
3 ☐ Case Conference and Presentation Once after final examination
(as scheduled)

CHECKLIST OF FI REQUIREMENTS
FI 1, 1 ST SEMESTER , AY 2019-2020