Republic of the Philippines

PRESIDENT RAMON MAGSAYSAY STATE UNIVERSITY

Iba, Zambales, Philippines
Tel./Fax No. (047) 811-1683|rmtupresident@yahoo.com
www.prmsu.edu.ph

INTERNSHIP APPLICATION FORM

___________________ Latest 2x2 Photo in

Date
Formal Attire with
White Background
and Name tag
Dr. SANTI A. MAGTALAS
Dean, College of Arts and Sciences
PRMSU, Iba, Zambales

Sir

I have the honor to apply for On-The-Job-Training in compliance with the requirements of my course, Bachelor
of Science in Biology/Psychology.

Name: Curriculum Year:

Last Name First Name Middle Name
Date of Birth: ____________________________ Sex: [ ] Male [ ] Female
MM/DD/YYYY
Age: Civil Status: Active Mobile No.:
Permanent Address/ Current::
__________________________________________________________________________________
Scholarship (if any):

Membership in Student Organization:

Position: ________________________________

Preferred place of training (Please indicate name/s and address/es of establishment/s):

___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________

In case of emergency, please notify:

Name: Relationship:
Current Address: Active Contact No. :

I have discussed with my parent/guardian the importance of this training to my course and that they have given me their
consent.

______________________________ _______________________________
Student Signature over Printed Name Parent/ Guardian’s Signature over Printed Name

Noted: Approved:

KATRINA E. PAJELA, LPT SANTI A. MAGTALAS, Ed. D.

SIPP/ SIAP Coordinator/ Program Chairperson College Dean