Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

Tamag, Vigan City
2700 Ilocos Sur

PARENT’S CONSENT

KNOW ALL MEN BY THESE PRESENTS:

I/We _________________________________________________ (parent/guardian)

of _________________________________________________ (son/daughter/ward), hereby
expressly permit my son/daughter to have his/her Internship to the perspective Host Training
Establishment for the Second Term of School Year 2022 – 2023. In connection to this, I/we
are aware that the aforementioned activity is a requirement of the course in consonance with
CHED Memorandum Order (CMO) No. 104, series 2017. Furthermore, I/we are bound to
abide by the rules and regulations of the school and the Host Training Establishment where
he/she will serve his/her Internship.

__________________________________ __________________________________
Signature over Printed Name of Signature over Printed Name of
Parent / Guardian Parent / Guardian

ID No.________________________ ID No.________________________
(government issued ID) (government issued ID)

ACKNOWLEDGEMENT

REPUBLIC OF THE PHILIPPINES )

CITY OF VIGAN )S.S.

BEFORE ME, a Notary Public for and in the Province of Ilocos Sur, personally
appeared above-named person/s with ID Number written below their names, known to me and
to me known to be the same person/s who executed the foregoing instrument which he/she/they
acknowledge to me as voluntary act.

WITNESS MY HAND AND SEAL this ______ day of ________________________,

2023 at Vigan City, Ilocos Sur.

Doc. No.: _____;

Page No.: _____;
Book No.: _____;
Series of 2023.

Quirino Blvd., Brgy. Tamag, Vigan City, 2700 Ilocos Sur ISO 9001:2015
Website: www.unp.edu.ph
REGISTERED