M/T/W

FORM FOR STUDENT INTERNSHIP IN PHYSICS DIVISION Date:

INSTITUTE OF MATHEMATICAL SCIENCES AND PHYSICS, COLLEGE OF ARTS AND SCIENCES, UNIVERSITY OF THE PHILIPPINES LOS BAÑOS year month day Th/F/Sa

I. REQUESTING SCHOOL/UNIVERSITY Duration of internship: from 2019 06 01 to 2019 07 26 Period: ___ days
year month day year month day

Name of School : PHILIPPINE SCIENCE HIGH SCHOOL MAIN CAMPUS

Address : AGHAM ROAD, DILIMAN, QUEZON CITY
Contact No. : 09177267598 Contact Person : BHAZEL ANNE R. PELICANO
Email: sip.mc@pshs.edu.ph, brpelicano@pshs.edu.ph Designation : SIP COORDINATOR

II. STUDENTS INVOLVED

Limit the students listed in one form to a group of students under one host supervisor. The students listed in this form must also share the same project or nature of
internship. If there are several groups under one host supervisor with different projects or natures of internship, each group should fill out separate form.

Last Name, Given Name(s), MI, Suffix(Jr or III, IV, etc)

Name : ANTON DASALLA Signature :

(Grade or Uni-
Level : 11 versity Level) Email Add : Contact No. :

Last Name, Given Name(s), MI, Suffix(Jr or III, IV, etc)

Name : KLARENCE TOMAS CERVANTES Signature :

(Grade or Uni-
Level : versity Level) Email Add : Contact No. :

Last Name, Given Name(s), MI, Suffix(Jr or III, IV, etc)

Name : MEJILLA, Eduard James G. Signature :

Physics Division Form 2019_0224Su Allan L. Alinea

(Grade or Uni-
Level : 11 versity Level) Email Add : ejgmejilla@gmail.com Contact No. : 0933816766

Last Name, Given Name(s), MI, Suffix(Jr or III, IV, etc)

Name : SANTOS, Cyd Nicolas A. Signature :

(Grade or Uni-
Level : 11 versity Level) Email Add : b21.cyd.santos@pshs.edu.ph Contact No. : 0956 038 9178

Last Name, Given Name(s), MI, Suffix(Jr or III, IV, etc)

Name : Signature :
(Grade or Uni-
Level : versity Level) Email Add : Contact No. :

You may state below in paragraph or bullet form, information about the reason(s) for internship (e.g., course/class requirement,
III. NATURE OF THE INTERNSHIP research, etc.), objectives, its scope and limitation, and responsibilities of the students and their home school or university.

The Science Immersion Program (SIP) is a required, nongraded course in the new 6-year PSHS curriculum. It can be taken before the start of the academic year for incoming
Grades 10 to 12 students. The SIP is a two- or three-week internship program with a minimum of 80 hours official internship time in a participating science or research
institution. Ideally, student-interns will be assigned to the institution based on their interests and chosen specialization for Grades 11 and 12.

Through the SIP, student-interns are expected to:

• learn science, engineering, and research laboratory skills and concepts;
• foster interactions with researchers, scientists, and technical personnel as they participate in research projects;
• be exposed to basic science or engineering principles applied in the operation of the facility;
• identify possible research problems to be pursued as projects in the future; and
• establish linkages with institutions especially for future collaborations.

List down the equipments and rooms that may

IV. NATURE OF INVOLVEMENT OF THE HOST SUPERVISOR V. EQUIPMENTS AND ROOMS be used during the internship.
(to be filled out by or in consultation with the host supervisor) (to be filled out by or in consultation with the host supervisor)

The persons with their names and signatures below endorse

VI. ENDORSEMENT the internship of all the students listed in Part II. VII. APPROVAL

Allan L. Alinea Chrysline Margus N. Piñol

Adviser Department Host Supervisor Head, Physics Division Director, IMSP
or Instructor or School Head under Physics Division Recommending Approval Approved/Disapproved