Undertaken at

Type the name of the Company here!

Presented to the Office of

Student Internship Program

In partial fulfillment of the requirements

for the Degree
Bachelor of Technology

Major: Food Technology

JUAN DELA CRUZ

Name of Student Trainee
School Year 2019-2020
 SAMAR STATE UNIVERSITY
OFFICE OF STUDENT INTERNSHIP PROGRAM
Catbalogan City, Samar

TABLE OF CONTENTS
Pages

I. Title Page . . . . . . . . . . . . . . 1
II. Table of Contents. . . . . . . . . . . . . 2
III. Acknowledgement. . . . . . . . . . . . . 3
IV. Introduction. . . . . . . . . . . . . . . 4
V. My Preparation for Internship. . . . . . . . . . . 5
VI. Company Profile. . . . . . . . . . . . . . 6
 Front picture of the company (with caption below for the . . . .

PUT CORRESPONDING PAGES HERE

complete address /Company contact numbers)
 History of the company. . . . . . . . . . .
 Company Vision and Mission. . . . . . . . .
 Company Organizational Chart. . . . . . . . .
VII. Narrative Report. . . . . . . . . . . . . .
 Narrative Report on Weekly Activities

VIII. Pictorials with Caption. . . . . . . . . . . .

DELETE ME AFTER READING

 Pictorials Working on Duty
 Pictorials with co-worker
 Pictorials with the Supervisor
IX. Conclusions. . . . . . . . . . . . . . .
X. Recommendations. . . . . . . . . . . . .
 Potential of the Company as a Training Ground. . . . .

PUT CORRESPONDING PAGES HERE

 Availability and appropriateness of facilities, tools,
machinery and Equipment.. . . . . . . . . .
 Company Personnel Cooperation with the trainee . . . .
 Proposed Revisions for the Improvement of the
SSU OJT Training Program (Advice to Future Student-Trainee). .
XI. Appendices. . . . . . . . . . . . . . .

A. Student Intern Personal Information. . . . . . .

B. SSU-SIP-FR-002. . . . . . . . . . .
C. SSU- SIP -FR-003. . . . . . . . . .
D. SSU- SIP -FR-004
E. SSU- SIP -FR-005. . . . . . . . . .
F. SSU- SIP -FR-006 (attached Daily Time Record or DTR’s per month).
G. SSU- SIP -FR-007. . . . . . . . . .
H. SSU- SIP -FR-008. . . . . . . . . .
I. CERTIFICATE OF COMPLETION (duly signed by Supervisor/Manager).
J. SSU- SIP -FR-009 (signed by the manager/representative/Notarized.

Page 2 of 16
 SAMAR STATE UNIVERSITY
OFFICE OF STUDENT INTERNSHIP PROGRAM
Catbalogan City, Samar

III. Acknowledgement

REMEMBER!!!

USE THE FOLLOWING REQUIREMENTS

FOR ENCODING:

FONT: ARIAL
FONT SIZE: 11
LINE SPACING: 1.5
PAPER SIZE: A4

DELETE ME AFTER READING!!

Page 3 of 16
 SAMAR STATE UNIVERSITY
OFFICE OF STUDENT INTERNSHIP PROGRAM
Catbalogan City, Samar

IV. Introduction

Page 4 of 16
 SAMAR STATE UNIVERSITY
OFFICE OF STUDENT INTERNSHIP PROGRAM
Catbalogan City, Samar

V. My Preparation for Internship

Page 5 of 16
 SAMAR STATE UNIVERSITY
OFFICE OF STUDENT INTERNSHIP PROGRAM
Catbalogan City, Samar

VI. Company Profile

 Front picture of the company (with caption below for the complete address
/Company contact numbers and name of contact Person )

 History of the company

 Company Vision and Mission

 Company Organizational Chart

Page 6 of 16
 SAMAR STATE UNIVERSITY
OFFICE OF STUDENT INTERNSHIP PROGRAM
Catbalogan City, Samar

VI. Narrative Report

Narrative Report on Weekly Activities

Week 1 April 2 – 6, 2019 40 hours

Discuss/Narrate here in paragraph form all the specific

activities/jobs/assignment/experiences you have done for the whole week. (2 weeks per
page and 50 words minimum)

REMEMBER!!!

USE THE FOLLOWING REQUIREMENTS

FOR ENCODING:

FONT: ARIAL
FONT SIZE: 11
LINE SPACING: 1.5
PAPER SIZE: A4

DELETE ME AFTER READING!!

Week 2 April 9 – 13, 2019 40 hours

Page 7 of 16
 SAMAR STATE UNIVERSITY
OFFICE OF STUDENT INTERNSHIP PROGRAM
Catbalogan City, Samar

Week 3 April 20 – 24, 2019 40 hours

Week 4 April 25 – 29, 2017 40 hours

Page 8 of 16
 SAMAR STATE UNIVERSITY
OFFICE OF STUDENT INTERNSHIP PROGRAM
Catbalogan City, Samar

Week 5 April 30 – May 4, 2017 40 hours

Week 6 May 5 – 9, 2017 40 hours

Continue below to complete your number of hours per week.. (delete me after reading)

Page 9 of 16
 SAMAR STATE UNIVERSITY
OFFICE OF STUDENT INTERNSHIP PROGRAM
Catbalogan City, Samar

VII. Pictorials with Caption

 Pictorials Working on Duty ( at least 2 pictures/ one page)

 Pictorials with the co-worker ( at least 2 pictures/ one page)

 Pictorials with the Supervisor ( at least 2 pictures/one page)

Page 10 of 16
 SAMAR STATE UNIVERSITY
OFFICE OF STUDENT INTERNSHIP PROGRAM
Catbalogan City, Samar

VIII. Conclusions

Page 11 of 16
 SAMAR STATE UNIVERSITY
OFFICE OF STUDENT INTERNSHIP PROGRAM
Catbalogan City, Samar

IX. Recommendations

 Potential of the Company as a Training Ground

 Availability and Appropriateness of facilities, tools, machinery and Equipment.

 Company Personnel Cooperation

Page 12 of 16
 SAMAR STATE UNIVERSITY
OFFICE OF STUDENT INTERNSHIP PROGRAM
Catbalogan City, Samar

 Proposed Revisions for the Improvement of the SSU -Internship Program

(Advise to Future Student Interns)

Page 13 of 16
 SAMAR STATE UNIVERSITY
OFFICE OF STUDENT INTERNSHIP PROGRAM
Catbalogan City, Samar

ASSESSMENT OF HOST TRAINING ESTABLISHMENT BY STUDENT INTERN

Month ____________, 20 ____

Name of Student Intern (optional): _____________________________________________

Name of Establishment: _____________________________________________________
Place/Area of Assignment:___________________________________________________

The purpose of this form is to provide the University with feedback on the
effectiveness of the Host Training Establishment in delivering its services to the student
interns. Please encircle your answer objectively and in all honesty. Rest assured that the
Office of Student Internship Program will observe strict confidentiality of your answers.

The assessment ratings range from 1 to 5 are as follows:

1 – Unsatisfactory (Never demonstrates this obligation/ responsibility)
2 – Needs Improvement (Seldom demonstrates this obligation responsibility)
3 – Fair (Sometimes demonstrates this obligation responsibility)
4 – Good (Usually demonstrate this obligation responsibility)
5 – Excellent (Always demonstrates this obligation/ responsibility)
N/A – Not Applicable (Not applicable to this internship experience)

No. Obligation/Responsibility Rating

Implements the internship plan in partnership with the
1 1 2 3 4 5 N/A
University at all times.
Encourages student intern to develop his/her personality and
2 professionalism, and, to the extent possible, protect him/her 1 2 3 4 5 N/A
from physical or moral danger.
The site supervisor exercises utmost responsibility in the
3 1 2 3 4 5 N/A
implementation of all internship phases.
Provides practical training or work experience in accordance
4 1 2 3 4 5 N/A
with the agreed internship plan and schedule of activities.
Ensures that student intern does not perform tasks and
5 1 2 3 4 5 N/A
duties of regular position in the agency/industry at all times.
Helps enhance the knowledge, skills, attitudes, and values of
6 1 2 3 4 5 N/A
the student intern.
Provides internship training in the form of actual exposure in
7
the various departments or units of the company.
Provides necessary incentives to the student intern such as:
(Please underline the incentive/s) free duty meals, travel
8 1 2 3 4 5 N/A
allowance, uniform, lodging, working hours, days off,
insurance. Others (please specify): ______________
Provides harmonious relationship and comfortable 1 2 3 4 5 N/A
9
atmosphere.
10 Has working areas/sites conducive to learning/training. 1 2 3 4 5 N/A

Comments/Suggestions:
________________________________________________________________________
________________________________________________________________________

***Send/Hand this completed survey form to the Program Internship Coordinator./or

attached it in your narrative report*** Thank you.

Page 14 of 16
 SAMAR STATE UNIVERSITY
OFFICE OF STUDENT INTERNSHIP PROGRAM
Catbalogan City, Samar

STUDENT INTERN PERSONAL INFORMATION

Name: Juan Dela Cruz Import ID picture

Address: Arteche Blvd. Barangay Guindapunan, Catbalogan City here!!
Mobile: 09176524422 / 09093456777

PERSONAL DATA
Age :
Sex :
Birthdate :
Place of Birth :
PARENTS INFORMATION OCCUPATION
Father :
Mother :
EDUCATIONAL BACKGROUND Year
Elementary :
Secondary :
College :
College Course :
Major :
Year & Section :
INTERNSHIP TRAINING INFORMATION
Name of Company :
Complete Address :
Contact Number :
Name of Supervisor : Mobile Number :
Total Training Hours :
Dept. Section Assigned :
Semester/School Year :

JUAN DELA CRUZ

Student Intern/Signature

Page 15 of 16
 SAMAR STATE UNIVERSITY
OFFICE OF STUDENT INTERNSHIP PROGRAM
Catbalogan City, Samar

APPENDICES
(Attached the following SIP Entry and Exit forms)

A. SSU-SIP-FR-002. Recommendation Letter

B. SSU- SIP -FR-003. Student Internship Curriculum Vitae

C. SSU- SIP -FR-004. On the Job Training Agreement

D. SSU- SIP -FR-005. Student Pledge and Waiver

E. SSU- SIP -FR-006. OJT Weekly Accomplishment Record Sheet

(Attached Daily Time Record or DTR’s per month).

F. SSU- SIP -FR-007. Internship Evaluation Progress Report ( with rating)

G. SSU- SIP -FR-008. Internship Performance Assessment

H. SIP CERTIFICATE OF COMPLETION (From Company duly signed by

Supervisor/Manager)

I. SSU- SIP -009. Memorandum of Agreement (signed by the manager/representative

and DULY NOTARIZED)

Page 16 of 16