Republic of the Philippines
ZAMBOANGA STATE COLLEGE OF MARINE SCIENCES AND TECHNOLOGY
Fort Pilar, Zamboanga City
Tel No.: (062) 993-2615 Telefax: (062) 991-0777 website: http://www.zscmst.edu.ph
ZSCMST-OIAO-3.2.4.2.1
OJT/Internship Assistance Office Adopted Date: 2008
Revision Date: Nov 2024
Revision Status: 4
REGISTRATION FORM FOR PRACTICE TEACHING/PRACTICUM/OJT
Name: _____________________________________________________Student No._____________________
Family Name Given Name Middle Name
College: _______________________________Course: _________________________Major: _______________
Home Address: _____________________________________________________________________________
Contact Details Cell Phone number: _____________________Email: __________________________________
Name of Parent/Guardian: __________________________________________ __________________________
Printed Name Signature
CHECKLIST OF REQUIREMENTS FOR SUBMISSION:
Copy of Accepted Request Letter by the HTE
Copy of Notarized Memorandum of Agreement/Memorandum of Understanding (MOA)
Certificate of Psychological Exam Completion from GCO
Certificate of Attendance of Pre-Deployment Orientation Seminar (PDOS)
Registrar’s Certificate
Medical Certificate
o Drug Test
o Xray
o CBC
o Urinalysis
o Pregnancy Test
o Fecal Analysis
o Others: ____________________________
Certificate of Good Moral Character
Notarized Training Agreement and Liability Waiver (if applicable)
Notarize Parental Consent with 2 valid IDs with signature
Certificate of Paid Group Insurance
Certificate of Registration (COR)
Student-Trainee’s Personal History Statement/Resume’
Copy of Internship Training Plan
Certificate of employment with attached job description (in the case of working student who wants to
consider their employment as their internship training)
Other requirements as may be prescribed by the training venue/cooperating company/agency
___________________________________________________________________________________
Inclusive date of training: __________________________________________________________
No. of hours: ______________________________________________________________________________
_______________________________
Trainee’s Signature over Printed Name
Reviewed by:
_____________________________________________
OJT Coordinator and Program Adviser
Recommending Approval:
____________________________________________
Head, OJT/Internship Assistance Office
Approved:
___________________________________
College Dean
