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Reference No. : OMSC-Form-COL-22 Effectivity Date: January 08, 2019 Revision No.

00

Republic of the Philippines


OCCIDENTAL MINDORO STATE COLLEGE
Mamburao, Occidental Mindoro
UNIT Website: www.omsc.edu.ph Email address: omsc_9747@yahoo.com
LOGO Tele/Fax: (043) 457-0231 CERTIFIED TO ISO 9001:2015
CERT. NO.: 50500782 QM15
(College)

SUMMARY OF INTERNSHIP ACTIVITIES

Name: Date:
Internship Site:
Date of Internship:

Name and Address of Cooperating


Agency:

Name and Title of Site Supervisor:

Brief Description of the division or unit of


Organization where you completed work:

Description of responsibilities and


Experiences:

Description of key to accomplishments or Outcomes:

Signature of Intern:

Signature of Site Supervisor:

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