FM-AA-INT-15

Rev. 0
03-Oct-2017

INTERNSHIP RELEASE FORM

PANGASINAN STATE UNIVERSITY
Bayambang Campus

_________________________
Date

_________________________

_________________________

_________________________

Course: _____________________________________

Major: __________________________

Upon completion and submission of all your required documents for your Internship /Practicum activity, you
are hereby released to undergo ___ hours Internship/Practicum at

Cooperating Company/Agency/Firm: ________________________________________

Company/Agency/Firm Address: ____________________________

From ______________, _______ to ______________, _______.

Please be guided with the school and company Internship/Practicum policies and guidelines throughout the
duration of your Internship/Practicum Activity

__PETER PAT-RICK B. MIGUEL__

Campus Internship Coordinator

VENUS MAY H. SARMIENTO, MDM

Internship/Practicum Subject Instructor

Noted:

ARMANDO D. JUNIO, Ph. D

__GUDELIA M, SAMSON, DPA__
Campus Executive Director