University of San Agustin

COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSION

DEPARTMENT OF PHARMACY
ILOILO CITY, PHILIPPINES 5000

APPLICATION FORM FOR INTERNSHIP TRAINING

COMMUNITY PHARMACY INTERNSHIP HOSPITAL PHARMACY INTERNSHIP
MANUFACTURING PHARMACY INTERNSHIP MINOR 200 Hours MAJOR 360 Hours
SURNAME NAME MIDDLE NAME
NAME
INTONG KHRISMA JOANAH ESTAMPADOR

BLOCK 3 LOT 14 FORT LYTTON ST., PARC REGENCY RESIDENCES, BRGY UNGKA II. PAVIA, ILOILO CITY
CITY ADDRESS
BRGY. DAMIRES, JANIUAY, ILOILO
PROVINCIAL ADDRESS
khrisma_joanah@yahoo.com PERSONAL CONTACT NUMBER/S.
E-MAIL ADDRESS 09271250419
AGE BIRTHDAY SEX CIVIL STATUS
19 December 01, 1998 _____ Male _____ Single
_____ Widow/er
_____ Female _____ Married
CONTACT PERSON/S IN CASE OF EMERGENCY RELATIONSHIP CONTACT NUMBER/S
1.KHRISTIA KARA E. INTONG SISTER 09064086321
2.
EDUCATIONAL BACKGROUND
LEVEL NAME OF THE INSTITUTION AWARD/S RECEIVED
ELEMENTARY St. Julian Academy 8TH in Rank with Honors
SECONDARY St. Julian Academy 5th in Rank with Honors
TERTIARY University of San Agustin
SKILLS

 Ability to work and cooperate well with other people

 Ability to prioritize tasks and follow instructions carefully
 Ability to work under pressure
 Having initiative in complying assigned works

PREVIOUS INTERNSHIP TRAINING

COMMUNITY PHARMACY INTERNSHIP I.S MEDICINE CORNER-TAGBAK
HOSPITAL PHARMACY INTERNSHIP ILOILO DOCTORS’ HOSPITAL
MANUFACTURING PHARMACY INTERNSHIP

INSTITUTION/COMPANY APPLIED FOR INTERNSHIP

NAME OF INSTITUTION/COMPANY CONTACT NUMBER

E-MAIL ADDRESS

ADDRESS:
CONTACT PERSON POSITION

REASON/S FOR CHOOSING THE COMPANY/INSTITUTION:

It is not just about compliance of a 200 hour manufacturing pharmacy internship, but also an opportunity to gain knowledge,
skills, experiences and abilities that would shape my capabilities in a manufacturing field. I want to learn how drugs are being
manufactured and how quality control processes are being done. Lastly, I want to learn how they impart good quality products
that would satisfactorily provide the needs of many people.

I certify that all statements in this application are true and complete to the best of my knowledge. I understand that a false or
incomplete answer may be grounds for not considering me or discontinuation of my internship.

Signature: _____________________________________________ Date: __________________________

VIRTUS et SCIENTIA