Republic of the Philippines ! PRESIDENT RAMON MAGSAYSAY STATE UNIVERSITY Iba, Zambales ‘Telefax (047) 811-1683 -COLLEGE OF TEACHER EDUCA STUDENT TEACHER'S PERSONAL DATA SHE] 1X1 PICTURE Personal Information PRINT: ast Name First Name Middle Name Address: Contact Number: Email Address: Date of Birth: Nationality Height (Fi Father's Nami Occupation Mother's Name: Occupation: Parent's Addres Language, Dialect, fluently us Person to Contact in Case of Emergency Relationship Contact Number: Monthly Income: Educational Background Element ‘Year Graduated: Secondary: ‘Year Graduated Vocational Course ‘Year Graduated: Honors Received: Awards Received: Special Skills: _ Character Reference Name Position ‘Contact Number This is to certify that the information written on this form is true and correct, verified by me to the best of my knowledge and belief. ST Signature over Printed NameRepublic of the Philippines PRESIDENT RAMON MAGSAYSAY STATE UNIVERSITY Tha, Zambales ‘Telefax (047) 811-1683 ~COLLEGE OF TEACHER EDUC OTE: MEDICAL CERTIFICATE Name of Institution : PRESIDENT RAMON MAGSAYSAY STATE UNIVERSITY Address : tba, Zambales Region mW Name Of The Student Teacher: Surname First Middle Date of Birth: Place of Birth: Height (in meters) ‘Weight (in kgs) Heart Rate (at rest): Blood Pressure (at rest): Physical Signs Disorder of: YES NO YES NO Heart oO Mammary Glands () () Vascular System OO Endocrine Organs () () Lungs" QQ Locomotor Organs () () Liver OO Lymph Glands () () Spleen OO Genital Organs () () If yes, give details under Remarks. REMARKS, Do you consider the student teacher at present for his/her practice teaching this 15 semester 2018-20187 YES() NO() Name of Examining Physician: Signature Date: * attached copy of Chest-Xray result [Form NoPRUSU-ASA-CTESF23_| Revision No. 00 | Effectivity Date: August’5. 2010 [Page tofRepublic of the Philippines Tha, Zambales ‘Telefisx (047) 811-1683 -COLLEGE OF TEACHER EDUC&¥10 FINAL DEMONSTRATION OBSERVATION / EVALUATION|CHE Name of Mente __ Name of Mentor: __ Suabjeet Taught: Time: pate Divesion: Seiden Teacher willbe raid wang the scale OT TOU down to 70.” | A TEACHER'S PERSONALITY The teacher i neat and well-groomed PRESIDENT RAMON MAGSAYSA YeSTATE UNIVERSITY reAvS_ D5 8 1 ates! Schoo! 7 2, The teacher is Gee from mannerism that tend to distarb the studeat's attention 3._The teacher's personality is strong enough to command respect and attr 4._Ths teacher shows dynamism and enthusiasm B._LESSON PLANNING [5 Tesson plan i well prepared There is congruence Benween: {6._Objective and subject matter "7. Objective and teaching procedure [5 Objertive and formative test ‘Objective and assignment ©_CONTENT TO. “The teacher demonstrates in depih knowledge of the Subject manet Ti. He She is able 10 present lessons to actual life staatioas 12, Gives sufficient and concrete examples to create meaningial earning experience® D,_ TEACHING METHODS TS. Makes effective review and motivation é Methods used were suited 10 the needs and capabililies of he sadens | 15-The teacher was creative enough to adapt his her method to the students cape 16. Provides varied learning taiks 17. Wisual aids and other examples were used 19 Whustrate the Tessoa) TS, Focuses students” attention on important poinis when summartzing 19. Integrates moral values inthe lesson 20, The teacher made effective use of the Tormaiive test after teaching E,_ CLASSROOM MANAGEMENT Tie teacher had a systematic way of checking 21. Anendance 22._ Assignment HomeworkAgrecment 23, Practice Exercises/Group Work/Projecis 24. Onder and discipline were present in the classroom: F QUESTIONING SKILLS (Teacher's questioning skill stimulates different ways such us) 25. Proving for learner's understanding 26. Helped students articulate their ideas and thinking Sis 7, Encourage convergent and divergent thinking 28, Stimulate curiosity and helps students wo ask questions TOTAL FINAL RATING L Feedback, Signature of Observer/Evaluator over printed nameRepublic of the Philippines PRESIDENT RAMON MAGSAYSAY STATE UNIVERSITY Iba, Zambales Telefax (047) 811-1683 Name: Date: Course: SY. ‘The Student Teacher whose name appeared above will be pulled out from due to Cooperating Teacher Cooperating School Head Teacher Recommending Approval: Approved ‘LENVI ANN M. MACALINAO, PhD. Dean, CTERepublic of the Philippines PRESIDENT RAMON MAGSAYSAY STATE UNIVERSITY Tba, Zambales ‘Telefax (047) 811-1683 -COLLEGE OF TEACHER EDU CERTIFICATE OF PARENTAL CONTRACT We & who are legal parents / guardians of with residence at do hereby certify that we give our full support for his/her practice teaching at_ from to 5 All expenses incurred this activity will be taken into our custody. No. 00 | Effectivity Date: August 5, 2019 | Page 7 of 7 [Form No. PRMSU-ASA-CTESF16Republic of the Philippines PRESIDENT RAMON MAGSAYSAY STATE UNIVERSITY Iba, Zambales ‘Telefax (047) 811-1683 1 ‘OLLEGE OF TEACHER EDUCATION. STUDENT TEACHING (ST) PRO WAIVER, a Student Teacher in (Course) of the President Ramon Magsaysay State University hereby voluntarily declare and agree to undergo Student Teaching at under the following terms and conditions: That I recognize the authority of the school where | will eonduet my Student Teaching and voluntarily submit myself to abide with the rules and regulations that may be imposed upon me during the duration of my training. That my non-compliance to such will cause my ineligibitity for further participation in the said training program; As a Student Teacher, I waive my claim against the Cooperating School and the President Ramon ‘Magsaysay State University, for the injury that may encounter. That | further agree to subject myself for search if warranted, for any loss that I may commit, either personal or financial as I undergo training. ‘That, 1 am aware that the University which I represent will not be held responsible for any damage, injury or liabilities caused by me, that | wil While in the performance of my duties and functions during my training period. ‘That, I shall exercise due diligence and care in any task assigned to me. ‘That, I declare and acknowledge this waiver to my free acts and need. personally suffer the consequences for acts committed Signed at Iba, Zambales, this day of, 2019. Signature ST over Printed Name WITH CONSENT / APPROVAL OF GUARDIAN jgnature of Parent / Guardian Over Printed Name Address: Community Tax No. (Form No: PRMSU-ASA-CTESF17 | Revision No. 00 | Effectivity Date: August 5, 2019 | Page 1 of 1PARENT'S/GUARDIAN’S CONSENT FOR THE CONDUCT OF PRMSU LIMITED FACE-TO-FACE CLASSES (Name of Parent/Guardian) hereby voluntarily give my consent to (Name of Student) under the College of, (Name of College, Course/Year Level/Section) to participate in the limited face-to-face classes at PRMSU (Campus). I attest that my son/daughter is fully vaccinated and has/have no comorbidities or any related illness. [ understand that PRMSU shall implement the minimum public health standards set by the government to minimize risk of the spread of COVID-19. I understand that my son/daughter's in-person attendance in the school will include ide ofthe school. I confirm that my son/daughter currently has none of the symptoms related to COVID- associating with teachers, fellow learners and school personnel, and other persons inside and out 19nd is/are in good health, I will not allow my son/daughter to physically go to school to attend classes if my son/daughter or any member of my household develops any of the said symptoms or any other symptoms of illness that may or may not be related to COVID-19. Date Printed Name of Student Signature of Student Date : Printed Name of Student's Parent /Guardian: Signature of Student's Parent/Guardian;Republic of the Philippines PRESIDENT RAMON MAGSAYSAY STATE UNIVERSITY Iba, Zambales Telefax (047) 811-168: -COLLEGE OF TEACHER ED} oaTe:dfG 6 5 204 EVALUATION CHECKLIST FOR STUDENT TEACHER'S INTRRNSHIPT (For Cooperating Teacher’ Rating) ame of Mentee: ame of Mentor Course /Year/Major__——— «School Wear: Daie: oa ae a aaa RR +i] ea a vexcromsmnmnacran Ti agian ia a ee a RCT |Win apnea + fail. eoTa nea sa] se [Form No. PRMSU-ASA-CTESF20 _| Revision No. 00 | Effectivity Date: August 5, 2019 | Page 1 of 2D. | CLASSROOM MANAGEMENT 8%) T. Pays attention to routine matters in the classroom Z Handies disciplinary problems effectively Total | 2 __x.0s= E, | INSTRUCTIONAL SKILL (70%) T. Makes effective review and motivation 7. Gives clear direction and logical explanation “Asks appropriate and diferent kinds of questions Distributes questions among stadents 3. Gives incidental teaching when necessary |_| 6. Provides varied learning tasks 7. Hlandies stodents” wrong answers and gives reinforcement when necessary (verbal or non-verbal) 'E. Focuses students” attention on important points when summarizing 9. Guides students in summarizing main ideas / eoncepis learned. TO. Integrates moral values in the lesson TI. Provides appropriate assessment and evaluation T2, Presents homework / assignment property Total | ___ i= __x.7=__ FINALRATING Signature of Observer/Evaluator over printed name PRMSU s0 RY! ONTE! Form No:PRMSU-ASA-CTESF20_| Revision No. 00 | Effectivity Date: August 5, 2019 | Page 2 of 2