FM-AA-PPT-04

Rev. 02
10-Dec-2018

PRACTICE TEACHING RELEASE FORM

PANGASINAN STATE UNIVERSITY
Campus

_______________________
Date

_________________________

_________________________

_________________________

Course:

Major:

Dear Ms./Mr.____________________

Upon completion and submission of all your required documents for your Experiential Learning/Practicum
activity, you are hereby released to undergo Practice Teaching at

Cooperating School: ____________________________________________________

School Address: ________________________________________________________

From ______________, _______ to ______________, _______.

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

Respectfully yours,

_____________________________ _____________________________
Supervisor, Practice Teaching Supervisor, Practice Teaching

Noted:

_____________________________ _____________________________
Chair, Professional Education Dept. College Dean, College of Education

Approved:

_____________________________
Campus Executive Director