Ref. No.

: DO-OJT-DLS-03
Status : Rev.01
Date Issued: January 2016

DAILY LOG SHEET

Name of Student Teacher

Period Covered
Name of School
School Address
Contact No.
Cooperating Teacher
Department

TIME
DATE SIGNATURE ACTIVITY
IN OUT

Student Intern : ________________________________________

Signature over Printed Name

Validated by : ________________________________________
Cooperating Teacher
 Ref. No.: DO-OJT-PC-04
Status : Rev.01
Date Issued: January 2016

PROGRESS CHART

Name of Student Teacher

Period Covered
Name of School
School Address
Contact No.
Cooperating Teacher
Department

No. of
Date Tasks/ Activities Performed Hours
Rendered

TOTAL NUMBER OF HOURS RENDERED

Prepared by: Checked by:

___________________________ ____________________________
Student Intern Cooperating Teacher
(Signature over Printed Name) (Signature over Printed Name)
 Ref. No.: DO-OJT-NR-05
Status : Rev.01
Date Issued: January 2016

NARRATIVE REPORT

Name of Student Teacher

Period Covered
Name of School
School Address
Contact No.
Cooperating Teacher
Department

NOTE: WRITE YOUR LEARNING/WORK EXPERIENCES OR INSIGHTS ON THE SPACE PROVIDED

WHILE YOU ARE HAVING YOUR PRACTICUM. (Use additional sheet if necessary).

Prepared by:

_________________________
Student Intern
(Signature over Printed Name)
 Ref. No. : DO-OJT-PG-06
Status : Rev.01
Date Issued: January 2016

POLICIES AND GUIDELINES

A. INTERN STUDENT
After the academic evaluation and the student qualities for the Practicum, he/she should:
1. Complete the required 360 hours of Internship.
2. Arrange with the cooperating school for his/her “works” schedule.
3. Comply with the requirements imposed by the school.
4. Observe diligently and religiously the policies, rules and regulations of the partner
school.
5. Shall submit all requirements of the Internship program.
6. Attain a “passing mark” in the Internship evaluation and appraisal given by the
school.

B. COOPERATING SCHOOL
As the training venue, the school is expected to:
1. Provide practicum student with relevant training aligned with his/her field of
specialization.
2. Assess and give objectives rating on the work performance of the intern student
utilizing the KNP Practice Teaching Appraisal Form.
3. Report to KNP any untoward or undesirable attitude shown by the student intern.
4. Terminate the services of the intern student brought about by serious infraction of
school policies, rules and regulations.
5. Provide or not an allowance to the intern student, depending on the school
policy.
6. Require on not the intern student to work beyond his/her practicum time
schedule, provided it is not in conflict with the academic schedule of the intern
student at KNP.
7. Perform other related functions and/or impose related requirements as long as
jointly agreed by both parties.

CONFORME:

_________________________ __________________________
Student Teacher Head of School
(Signature over printed Name) (Signature over printed Name)

Noted:
________________________
College Dean
 Ref. No. : DO-OJT-STCV-07
Status : Rev.01
Date Issued: January 2016

STUDENT TEACHER CURRICULUM VITAE

PERSONAL DATA:

Name:_________________________________________________________
Nickname:_____________________________________________________
Home Address:_________________________________________________
Age:_________ Civil Status: _______________ Gender:______________ 2X2 PHOTO
Cell No. _____________ Date of Birth: _____________________________
Place of Birth:__________________________________________________
Citizenship:___________________________

EDUCATIONAL BACKGROUND:

YEAR AWARDS
SCHOOL & ADDRESS
GRADUATED RECEIVED
Elementary:

Secondary:

College:

Course:

Special Skills:
____________________________________________________________________________

WORK EXPERIENCES: (including other apprenticeship)

Duration
Name of Company Address of the Company Position
Period

SEMINARS ATTENDED:

Title of Seminar Date and Venue Sponsor

CHARACTER REFERENCES:

Name Position Address of Company

I hereby acknowledge to the best of my ability and integrity that all information contained herein
is true and correct.
 _____________
___________
Signature

Ref. No. : DO-OJT-PTAR-08

Status : Rev.01
Date Issued: January 2016

PRACTICE TEACHING APPRAISAL REPORT

(Name of School)

Name of Intern:____________________________________Course/Year:_________________
Date of Actual Internship/Training: From:_____________________ To:____________________
Total No. of Hours Earned:______________________________________________________

Directions: Kindly check the number that corresponds to you evaluation of the performance of
our student intern of your school. The following rating scale and its corresponding interpretation
will be your guide.

5- Outstanding 3- Satisfactory 1-Poor

4- Very Satisfactory 2- Fair

ITEMS 5 4 3 2 1
JOB KNOWLEDGE
1. Possesses knowledge and skills needed to perform the job
assignment.
2. Performs assigned job according to instructions given.
3. Adopts a system in doing assigned job.
4. Is creative and efficient in performing the job.
5. Applies work theories and concepts learned.
6. Works with quality output in mind.
JOB ATTITUDE
1. Reports to work on time.
2. Performs the job with interest and initiative
3. Shows commitment in doing the job assigned.
4. Maintains work ethics in the work setting.
5. Has positive outlook on assigned task.
6. Willing to work beyond the required hours when given additional
workload.
PERSONAL RELATIONSHIP
1. Respects superiors, peers and subordinates.
2. Establishes rapport with co-trainees and employees.
3. Shows charitable acts even in small gestures.
4. Accepts feedback / criticism to correct weakness.

Remarks:

Rated by:
______________________________________
 Cooperating Teacher
( Signature over printed name)

Ref. No. : DO-OJT-CPSTAT-12

Status : Rev.01
Date Issued: January 2016

CHECKLIST FOR PRE-SERVICE TEACHER’S ACTUAL TEACHING

Name of Mentee: _________________________ Name of Mentor: _________________________

Subject Taught: __________________________ Date: _____________________ Time: __________

Name of School: ___________________________________________________________________

Criteria Observed Not Observed Remarks

I. TEACHER’S PERSONALITY
A. The teacher is neat and well-groomed.
B. The teacher is free from mannerisms that tend to
disturb the student’s attention.
C. The teacher’s personality is strong enough to
command respect and attention.
D. The teacher shows dynamism and enthusiasm.
E. The teacher has a well- modulated voice.
II. LESSON PLANNING
A. Lesson plan as well prepared.
B. There is congruence between:
1. Object and subject matter;
2. Objective and teaching procedure;
3. Objective and formative test, and
4. Objective and assignment.
III.CONTENT
A. The teacher demonstrates in depth knowledge of
subject matter.
B. S/he/ is able to relate lesson to actual life
situations.
C. The teacher keeps abreast of new ideas and
understanding in the field.
D. The teacher gives sufficient and concrete
examples to create meaningful learning
experiences.
IV. TEACHING METHODS
A. Method/s used is / are suited to the needs and
capabilities of the students.
B. The teacher is creative enough to adopt his/her
method to the student’s capabilities.
C. Visual Aids and other examples are used to
illustrate / enrich lesson.
D. The teacher makes effective use of the formative
test after teaching to measure student’s learning.
V. CLASSROOM MANAGEMENT
A. The teacher shows a systematic way of
checking:
1. Attendance
2. Assignment/Homework/Agreement
 3. Practice exercises
4. Group work/ projects
5. Student’s Passing in and out of the room
6. Correcting, distributing and collecting papers
B. Order and discipline are evident present in the
classroom.
C. Visual aids are within easy reach of the teacher
during his/her teaching.
VI. QUESTIONING SKILLS
The teacher’s questioning skills stimulate discussion
in different ways such as:
1. Probing for learner’s understanding;
2. Helping students articulate their ideas and
thinking process;
3. Promoting risk- taking and problem solving;
4. Facilitating factual recall;
5. Encouraging convergent and divergent thinking;
6. Stimulating curiosity, and
7. Helping students to ask questions.

Remarks:

Observed by:

______________________________________
Mentor
( Signature over printed name)