ANNEX C: Prescribed Template for the List of Tasks/ Activities to be done during Work Immersion

Name of Student Grade and Section

School Immersion Site
Track Strand/ Specialization
Duration of Work Immersion

School Partnerships Focal Person Contact Number

Work Immersion Teacher Contact Number

LIST OF TASKS/ACTIVITIES

Competencies Tasks/Activities Time Allotment Actual Schedule Remarks

Students shall not be given other activities outside of those previously agreed upon, which are anchored on the
stated competencies.

Certified true and correct:

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Student’s Signature Over Printed Name Parent’s Signature Over Printed Name

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Work Immersion Teacher’s Signature Industry Supervisor’s Signature
Over Printed Name Over Printed Name