Reference No.: OMSC-Form-COL-13 Effectivity Date: August 08, 2023 Revision No.

02

Republic of the Philippines

OCCIDENTAL MINDORO STATE COLLEGE
Labangan, San Jose, Occidental Mindoro
Website: www.omsc.edu.ph Email address: omsc_9747@yahoo.com
Tele/Fax: (043) 457-0231

College of Agriculture

INTERNSHIP APPROVAL FORM

Name: _______Sem: AY:__________

Address: Email add:
CP #:
Course:
Internship Coordinator:

Person who will supervise internship work:

Name: CP #:
Title: Email add:
Division/Unit:
Company/Agency:
Address:

List of the main duties that the intern will perform and the approximate percent of time on each day.

Duty % Time of Duty

Approved and signed by:

Site Supervisor __________________________________ Date: __________________

Intern __________________________________ Date: __________________

Intern Coordinator __________________________________ Date: __________________

Note: This form serves as a formal agreement among the intern, the site supervisor, and the
internship coordinator