FIELD INSTRUCTION/PRACTICUM APPLICATION FORM
I, _______________________________________________, ___________ resident of
(Name of OMSCIAN Student) (Age)
__________________________, Province of Occidental Mindoro, _________________
(Municipality) (Course/Year/Section)
would like to apply for practicum/field exposure/field instruction I / II, and other field work
related social work practice to develop my skills and competence requisite of the Bachelor of
Science in Social Work course for the undergraduate program.
Relative to this, I commit myself, time and attention, likewise my resource to maximize my
potentials and capacities under close-supervision of competent social work educators/social work
practitioners as I go along with the said field work/practicum, and allow myself be developed as
worthy graduate of this college.
_________________________________________________
Signature of OMSCIAN social work student over printed name
Attached are:
1. My brief autobiography
2. Student’s information Sheet (Biodata) with passport size picture
3. FI/Practicum form
4. Medical Certificate
5. Parent’s/guardian’s consent form
6. Proof of accident insurance coverage
