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PERSON-IN-CHARGE/
ACTIVITY DURATION
SUPERVISOR
D. Resources available for scholar-trainee’s use
COMPUTER
SOFTWARE OTHERS
Type No. of Units
Amount
[ ] Salary ______________
[ ] Transportation Allowance ______________
[ ] Daily Allowance ______________
[ ] Others, Please specify ______________
Prepared By:
Name : _______________________________________________________________________
Course and School : ____________________________________ Year of Award : __________
Institution/Company Assigned : ___________________________________________________
Company Address : _____________________________________________________________
Name of Supervisor : ____________________________________________________________
Designation : __________________________________________________________________
A. Organization
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
* R - Research NR - Non-research
B. Facilities (Laboratories/Machineries)
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
___________________________________________________________
III. PROBLEMS ENCOUNTERED
[ ] 1
Relationship with supervisor [ ] 6 Lack of resources
[ ] 2
Relationship with co-workers (references, chemical etc.)
[ ] 3
Inadequate training for job [ ] 7 Too much work assignment
[ ] 4
Insufficient amount of work [ ] 8 Insufficient time to complete work
assignment [ ] 9 Others
[ ] 5 Assignment of more
non-technical work
Below are statements to guide you in evaluating your performance and attitude
towards the training. Write the number that corresponds to your opinion on the box
after each statement using the following ratings:
AGREE 1 2 3 4 5 DISAGREE
V. RECOMMENDATIONS
Submitted By:
_______________________
Trainee’s Signature
_______________________
Date
SCIENCE EDUCATION INSTITUTE
Department of Science and Technology
TO THE EVALUATOR
Kindly fill-up the necessary information concerning performance and attitude of the
concerned scholar who undertook practical training in your company/institution.
Thank you for accommodating our trainee and for the assistance you have extended to
him/her.
A. Trainee’s Performance
FREQUENCY OR PERFORMANCE
ASSIGNED TASK
NO. OF HOURS RATING
1. Public Relations
Ability to get along with
a. Supervisor __________ ________________
b. Co-workers/co-trainees __________ ________________
2. Punctuality/Attendance __________ ________________
3. Knowledge of Trainee gained from school __________ ________________
4. Initiative __________ ________________
5. Intellectual Capacity __________ ________________
6. Dependability __________ ________________
C. Recommendations
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Rated By:
____________________________
Signature of Evaluator
____________________________
Printed Name and Designation
____________________________
Data
Conforme:
__________________________
Trainee’s Signature
__________________________
Date