Form NO.

BISU-F-TIP 012
BOHOL ISLAND STATE UNIVERSITY Revision: 00
C.P.G North Avenue, Tagbilaran City Effectivity Date: 08-01-2019
TEACHING INTERNSHIP PROGRAM

TEACHING INTERNSHIP CLEARANCE FORM

____________________
(Date)

Dear _______________________:
Practicum Supervisor

This is to inform you that ______________________________________________________ is cleared from all the

(Name of the Student Intern)

responsibilities / requirements in ________________________________________________. He / She has

completed (Name of the Cooperating School)

______________ hours as prescribed by your institution.

Very respectfully yours,

__________________________________________________
(Signature over Printed Name of the Cooperating Teacher)

Attested by:

__________________________________________________________
(Signature over Printed Name of the Teaching Internship Supervisor)