SHS Immersion Form 1 (Revised 2019)

VISAYAS STATE UNIVERSITY

Visca, Baybay City, Leyte
COLLEGE OF EDUCATION
VSU INTEGRATED HIGH SCHOOL

Evaluation of Student’s Immersion 2022

Name of Supervisor: Date:

Name of Student :
Track : Grade :

FIRST EVALUATION SECOND EVALUATION THIRD EVALUATION FOURTH EVALUATION

Criteria Rating Remarks
5 4 3 2 1
I. STUDENT’S WORK ETHICS
A. The Student is neat and well-groomed
B. The Student is courteous
C. The Student shows dynamism and enthusiasm
Rating: /15
(25 %) Weighted Rating:
II. STUDENT’S ACCOMPLISHMENT
A. The Student is punctual and prompt
B. The Student is time-on task oriented
C. The Student has accomplished task assigned
D. The Student attended / reported to Immersion Partner
regularly
E. The Student performed task diligently
F. The Student submitted reports / forms on time
Rating: /30
(50%) Weighted Rating:
III. STUDENT’S WORK RELATIONSHIP
A. The Student showed good relationship with the Immersion
Supervisor
B. The Student showed good relationship with the Immersion
Teacher
C. The Student showed good relationship with Co-immersion
Students
Rating: /15
(25 %) Weighted Rating:
Over-all Rating:

Rating Scale
5 - Outstanding Excellent 98 – 100
4 – Very Good Highly Outstanding 96 – 97
3 – Good / Fair Outstanding 93 – 95
2 – Poor Very Good 89 – 92
1 – Failed Good 85 – 88
Very Satisfactory 81 – 84
Satisfactory 79 – 80
Fair 77 – 78
Passed 75 – 76
Failed 74 – Below

Signature over printed name

Evaluator
SHS Immersion Form 2 (Revised 2019)
VISAYAS STATE UNIVERSITY
Visca, Baybay City, Leyte
COLLEGE OF EDUCATION
VSU INTEGRATED HIGH SCHOOL

Modified from (DepEd Order No. 30, s. 2017)

Name of Grade and

Student Section
School Immersion
Site
Track Strand /
Specialization
Duration
of Work
Immersio
n

Name of Contact
Supervisor Number
Work Immersion Contact
Teacher Number

LIST OF TASKS /ACTIVITIES Date:

(WEEKLY)
SKILL TASKS / ACTIVITIES TIME ALLOTMENT ACTUAL SCHEDULE REMARKS

Students shall not be given other activities outside the work immersion place and those not found in
the curriculum guide.

Certified true and correct:

Student’s Signature Over Printed Name Parent’s Signature Over Printed Name

Work Immersion Teacher Industry Supervisor’s Signature

Signature Over Printed Name Over Printed Name
SHS Immersion Form 3 (Revised 2019)
VISAYAS STATE UNIVERSITY
Visca, Baybay City, Leyte
COLLEGE OF EDUCATION
VSU INTEGRATED HIGH SCHOOL
 Rubric for Work Immersion Teaching Portfolio
S.Y. 2021 – 2022
Mentee:

Directions: Tick the box below the score that best describes the indicator. The legend below gives
the description of each score.

Criteria Rating
5 4 3 2 1
I. Visual Appeal (20%)
A. Cover
B. Lay-out
C. Tone/mood
D. Creativity
E. Resourcefulness
F. Neatness
Total Rating: /30
(20 %) Weighted Rating:
II. Organization (20%)
A. Order of Entries
B. Coding Technique
C. Readability of Entries
D. Correctness of Form (e.g. grammar)
Total Rating: /20
(20 %) Weighted Rating:
III. Content (30%)
A. Statement of Purpose
B. Completeness of Entries
Total Rating: /10
(30 %) Weighted Rating:
IV. Reflections (30%)
A. Depth of Understanding
B. Application of Ideas
Total Rating: /10
(30 %) Weighted Rating:
Over-all Rating:

Rating Scale
5 - Outstanding Excellent 98 – 100
4 – Very Good Highly Outstanding 96 – 97
3 – Good / Fair Outstanding 93 – 95
2 – Poor Very Good 89 – 92
1 – Failed Good 85 – 88
Very Satisfactory 81 – 84
Satisfactory 79 – 80
Fair 77 – 78
Signature of Evaluator / Immersion
Passed 75 – 76
Teacher Over Printed Name
Failed 74 – Below

VISAYAS STATE UNIVERSITY

Visca, Baybay City, Leyte
COLLEGE OF EDUCATION
VSU INTEGRATED HIGH SCHOOL
 Entries of Immersion Portfolio
Second Semester, S.Y. 2021 – 2022

Cover Page
Approval Sheet
Table of Contents

I. Statement of Purpose

II. Physical Condition of Immersion Cite

a. Description
b. Reflictions
c. Photos

III. Profile of Immersion Cite with Organizational Chart

IV. Weekly diary:

a. Narrative account of learning and achievement, issues faced and corresponding
resolution
b. Reflection

V. Work Immersion Highlight

a. Description
b. Photos

VI. Gallery

VII. Updated Resume

VIII. Reflection Paper

Note: At the end part, Evaluation Forms & DTR should be inserted/ included on the portfolio.