Republic of the Philippines

POLYTECHNIC UNIVERSITY OF THE PHILIPPINES

OFFICE OF THE VICE PRESIDENT FOR BRANCHES AND CAMPUSES OJT Form No. 1
MULANAY QUEZON BRANCH

Students OJT/Internship/Practicum Monitoring Form

Name of Trainer/Supervisor:___________________________________________ Training Station/s ____________________________________

Subject Code/Description:_____________________________________________ Date Submitted: _____________________________________

Signature
No. Name of Students
Tuesday Wednesd Thursday Friday Student/s Training Supervisor
Monday
ay

Student/s Training Supervisor

No. Name of Wednesd

Monday Tuesday Thursday Friday
Students ay

Bondoc Peninsula Highway, Brgy Sta. Rosa Mulanay, Quezon

Telephone Number: (042) 319-7599
Website: www.pup.edu.ph | Email: mulanay@pup.edu.ph | FB Page: PUP Mulanay

THE COUNTRY’S 1st POLYTECHNICU

 Republic of the Philippines
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES
OFFICE OF THE VICE PRESIDENT FOR BRANCHES AND CAMPUSES
MULANAY QUEZON BRANCH

Student/s Training Supervisor

No. Name of Wednesd

Monday Tuesday Thursday Friday
Students ay

4
OJT Form No. 2
5

STUDENT’S DISTRIBUTION TO PARTNER AGENCY

2nd Semester SY 2021-2022

Subject Code/Description: __________________________________________ Program/Year:______________________________

Target number of hours versus the

No. Name of Student/s Name of Office/Agency where the students deploy Date deployed number of hours gained by the student/s Remarks

Huryettha D. Marasigan
Huryettha D. Marasigan
1
Director’s Office PUP Mulanay April 25, 2022 600 hrs./300hrs Out of 36 DOMT III students 34 were
deployed in different agencies while the rest
experienced virtual OJT by attending
different seminars and training.

Bondoc Peninsula Highway, Brgy Sta. Rosa Mulanay, Quezon

Telephone Number: (042) 319-7599
Website: www.pup.edu.ph | Email: mulanay@pup.edu.ph | FB Page: PUP Mulanay

THE COUNTRY’S 1st POLYTECHNICU

 Republic of the Philippines
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES
OFFICE OF THE VICE PRESIDENT FOR BRANCHES AND CAMPUSES
MULANAY QUEZON BRANCH

Submitted by:

_____________________________________________________________
Name and Signature of the OJT/Internship/Practicum Supervisor/Date

Noted:

HURYETTHA D. MARASIGAN, LUISITO I. ASIA , MEM Dr. ADELIA R. ROADILLA, RGC

MPM Head, Academic Programs Director
OJT & QA Coordinator Date: Date:
Date: ____________________________
PRACTICUM STATION VISIT REPORT ____________________________
____________________________ __ __
PRACTICUM STATION VISIT REPORT
Station: ___________________________________________________________________ Date /Time of Visit: ______________________________

Attended by: _______________________________________________ _________________________________________

Name/Position/Designation of Training Supervisor Signature

Name of Students Visited Signature Remarks

(Comments/Recommendations of the Training Station Head
1

Bondoc Peninsula Highway, Brgy Sta. Rosa Mulanay, Quezon

Telephone Number: (042) 319-7599
Website: www.pup.edu.ph | Email: mulanay@pup.edu.ph | FB Page: PUP Mulanay

THE COUNTRY’S 1st POLYTECHNICU

 Republic of the Philippines
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES
OFFICE OF THE VICE PRESIDENT FOR BRANCHES AND CAMPUSES
MULANAY QUEZON BRANCH

Submitted by:

_____________________________________________________________
Name and Signature of the OJT/Internship/Practicum Instructor/Date

Noted:

HURYETTHA D. MARASIGAN, LUISITO I. ASIA , MEM Dr. ADELIA R. ROADILLA, RGC

MPM Head, Academic Programs Director
OJT & QA Coordinator Date: Date:
Date: ____________________________ ____________________________
____________________________ __ __

Bondoc Peninsula Highway, Brgy Sta. Rosa Mulanay, Quezon

Telephone Number: (042) 319-7599
Website: www.pup.edu.ph | Email: mulanay@pup.edu.ph | FB Page: PUP Mulanay

THE COUNTRY’S 1st POLYTECHNICU

 Republic of the Philippines OJT Form No. 3
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES
OFFICE OF THE VICE PRESIDENT FOR BRANCHES AND CAMPUSES
MULANAY QUEZON BRANCH

Status of students submission of OJT/Internship/Practicum requirements

2nd Semester SY 2021-2022

Students Requirements before OJT

Consent Vaccination ID Letter of
No. Name
form Card Appeal
Student/s Parent/s
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Bondoc Peninsula Highway, Brgy Sta. Rosa Mulanay, Quezon
Telephone Number: (042) 319-7599
Website: www.pup.edu.ph | Email: mulanay@pup.edu.ph | FB Page: PUP Mulanay

THE COUNTRY’S 1st POLYTECHNICU

 Republic of the Philippines
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES OJT Form No. 4
OFFICE OF THE VICE PRESIDENT FOR BRANCHES AND CAMPUSES
MULANAY QUEZON BRANCH

Status of students submission of OJT/Internship/Practicum requirements

2nd Semester SY 2021-2022

No. Name Students Requirements after OJT

Evaluation Form
MOA Endorsemen Internship Consen Resume’ OJT Form 1 Accomplishmen Professiona Certificate Employer/Training Student THE’s
t Letter Agreement t Form and DTR t Report l Readings Supervisor Intern
(Weekly, (Optional)
Monthly)
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Bondoc Peninsula Highway, Brgy Sta. Rosa Mulanay, Quezon

Telephone Number: (042) 319-7599
Website: www.pup.edu.ph | Email: mulanay@pup.edu.ph | FB Page: PUP Mulanay

THE COUNTRY’S 1st POLYTECHNICU

 Republic of the Philippines
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES
OFFICE OF THE VICE PRESIDENT FOR BRANCHES AND CAMPUSES
MULANAY QUEZON BRANCH

Bondoc Peninsula Highway, Brgy Sta. Rosa Mulanay, Quezon

Telephone Number: (042) 319-7599
Website: www.pup.edu.ph | Email: mulanay@pup.edu.ph | FB Page: PUP Mulanay

THE COUNTRY’S 1st POLYTECHNICU