FM-AA-INT-15

Rev. 0
01-Feb-2017

INTERNSHIP RELEASE FORM

PANGASINAN STATE UNIVERSITY

_________________________
Date

_________________________

_________________________

_________________________

Course: BSBA

Major: Operations Management

Upon completion and submission of all your required documents for your Internship / Practicum activity, you
are hereby released to undergo 40000 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

DR. KAREN LEA A. ESTIRA DR. MA. JASMINE J. DE GUZMAN LAZO

Internship / Practicum Subject Instructor Campus Internship Coordinator

Noted:

DR. RUBY ROSA V. CRUZ

Campus Executive Director