PGDT HPGD4606_APPENDIX 5

CO-TEACHER PRACTICUM INFORMATION

Name
:

IC Number :

Contact Number :

Email :

Highest academic qualification :

Area of specialisation :

Graduation year :

Teaching experience (year) :

I hereby declare that all the above information is correct

School principal name:

Signature and school stamp: Date:

___________________________ ______________________

Note for student-teacher: Please attached this form in the practicum Portfolio.