Ceat Ip Forms

Original copy – College Secretary
Duplicate copy – Dept. Chairman

Triplicate copy – Parent/Guardian
CEAT IP/EIR Form No. 1
CONSENT OF PARENT/GUARDIAN
University of the Philippines Los Baños

COLLEGE OF ENGINEERING AND AGRO-INDUSTRIAL TECHNOLOGY
College, Laguna
I, ____________________________________________, of legal age, residing at

_____________________________________________________________________, and
parent/guardian of ________________________________, student in the
Institute/Department of _____________________________________________, College of
Engineering and Agro-industrial Technology, U.P. Los Baños, College, Laguna, do hereby
authorize him/her/them/they to undertake internship/practicum/EIR outside the UPLB
Campus at _____________________________from _________ to _________. I understand
that Mr./Ms./Mx. _______________________________________________ will be guided by
the University rules on student conduct as if he/she/they were inside the UPLB campus and
also by pertinent rules and regulations of the HTE.
I hereby further agree to shoulder all personal and incidental expenses that may be
incurred by ______________________________________ in connection with this off-
campus internship required for successful completion of the student’s study program.
IN WITNESS WHEREOF, I have hereunto signed this affidavit this __________ day of
___________________, at _____________________________________.
________________________________
Affiant
WITNESSES:
__________________________________
__________________________________
__________________________________
Subscribed and sworn to before me this ______ day of ____________________ in the

Municipality of _____________________ Province of ________________, the affiant
exhibited to me his/her/their Residence Certificate No. __________________ issued at
_________________________ on ___________________.
__________________________
Notary Public
Doc. No. _______________________
Page No. _______________________ Until _________________________________
Book No. _______________________ TIN__________________________________
Original copy – College Secretary
Duplicate copy – Dept. Chairman
Triplicate copy – Parent/Guardian

S T U D E N T ‘S P L E D G E
University of the Philippines Los Baños

COLLEGE OF ENGINEERING AND AGRO-INDUSTRIAL TECHNOLOGY
College, Laguna
I, ______________________________________________________, a student in the

Institute/Department of _____________________________________________________,
College of Engineering and Agro-industrial Technology, U.P. Los Baños, College, Laguna, do
hereby agree and promise to abide by the rules on student conduct of the University while
undergoing internship/practicum/EIR at ____________________________________, as
well as the pertinent rules and regulations of the HTE.
I understand that during the period of my deployment as an intern/practicum/EIR

student, I shall be under the direct supervision of the HTE Supervisor or the student’s
representative or equivalent responsible staff/officer, in the absence, of my faculty-in-
charge/faculty adviser.
Signed in the presence of the Internship/Practicum/EIR Coordinator/Adviser:
______________________________
Name and Signature of the Student
_______________________________
Name and Signature of Internship/Practicum/EIR Coordinator/Adviser
_______________________________
Name and Signature of Division Head/Director/Chair
Performance Evaluation Form of the Immediate Supervisor
To the Supervisor,
Hereunder is the instrument for evaluating our students. Please answer the questions the
way you would appraise their performance. You may also attach your own instrument(s) to
support your assessment on the intern.
Student Information
Name of Intern: ____________________________________________________________
Course: __________________________________________________________________
Position/Line of Training: _____________________________________________________
Department/ Area of Assignment: ______________________________________________
Duration of Work: ___________________________________________________________
Hours spent as intern: _______________________________________________________
Job Description of Intern:
Company Information
Name of Evaluator: _________________________________________________________
Signature: _________________________________________________________________
Position/Office: _______________________________________________________
Company: ________________________________________________________________
Evaluation Instrument:
Grade Description Grade Description

Rating Scale:
95-100 Excellent 70-79 Satisfactory
90-94 Very Good 60-69 Fair
80-89 Good Below 60 Poor
CRITERIA GRADE
Punctuality and Attendance
Initiative
Discipline
Ability to work with minimum supervision
Communication Skills
Analytical Ability
Accuracy
Resourcefulness
Positive relationship with supervisor and co-workers
Comments/Recommendations:
OVERALL GRADE: __________________

CEAT IP Form 4.
Internship Report Format
The internship report should contain the following information:
Percentage
A. Systems Documentation 25%
1. Company Profile
2. General Processes (overview of system)
3. Detailed processes in the assigned area
- The student could make use of Flow/operation process charts, flow
diagram to describe the operations in the assigned area
4. Manpower Requirement
5. Machines and Equipment Used
6. Raw Materials Used and Finished Products
(include only the contents that are applicable to the company)
B. Application of Engineering tools and Techniques and related activities 40%
• The student must document trainings and relevant events attended
during the conduct of the student’s Internship.
• Relevant engineering tasks performed, and projects delegated
should also be included which must consist but not limited to the
following:
duration of tasks/project (use Gantt chart)
data gathered/utilized and how these data were used to perform
a particular task
results of the project
C. Potential Problems/Areas of Improvement 20%
• The student should be able to identify potential areas of
improvement and provide symptoms of problems or evidence of the
existence of the problem.
• Key Performance Indicators/metrics affected by the problem should
also be included.
D. Student’s Reflection 15%
• A reflection on the whole internship program is required together
with the associated impact of the training on personal/professional
growth.
• It must include thoughts on how theory and practice are
incorporated during the internship program.

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Original copy – College Secretary

Duplicate copy – Dept. Chairman

University of the Philippines Los Baños

I, ____________________________________________, of legal age, residing at

Subscribed and sworn to before me this ______ day of ____________________ in the

CEAT IP/EIR Form No. 2

University of the Philippines Los Baños

I, ______________________________________________________, a student in the

I understand that during the period of my deployment as an intern/practicum/EIR

Signed in the presence of the Internship/Practicum/EIR Coordinator/Adviser:

Name of Intern: ____________________________________________________________

Position/Line of Training: _____________________________________________________

Department/ Area of Assignment: ______________________________________________

Duration of Work: ___________________________________________________________

Hours spent as intern: _______________________________________________________

Job Description of Intern:

Name of Evaluator: _________________________________________________________

Grade Description Grade Description

OVERALL GRADE: __________________

The internship report should contain the following information:

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Subscribed and sworn to before me this day of ______________ in the