Professional Documents
Culture Documents
DT FORM 001
Candidate
SHEET NO.
1 of 1
SUMMARY
FIELD OF PRACTICE
%
(MAX.)
MINIMUM
CREDIT
HOURS
TOTAL NO. OF
HOURS
ACCOMPLISHED
30%
1152 hrs.
1232
25%
960 hrs.
1016
15%
576 hrs.
632
10%
384 hrs.
432
10%
384 hrs.
408
10%
384 hrs.
416
3840 hrs.
4136
TOTAL 100%
NOTE:
REMARKS
(To
be filled up by the PRC)
TRAINEE'S SIGNATURE
To be filled up by the Dean or Department head of school graduated:
ATTESTED BY:
IAPOA No.
Date Issued
Expiry Date
Candidate
PERIOD COVERED
PROJECT
TITLE/DESCRIPTION
& LOCATION
FROM
of Total No. of
Hours
TO
Day
Mo.
Yr.
Day
Mo.
Yr.
07
03
11
25
03
11
28
03
11
08
04
11
11
04
11
22
04
11
25
04
11
29
04
11
02
05
11
13
05
11
16
05
11
03
06
11
06
06
11
17
06
11
20
06
11
01
07
11
04
07
11
05
08
11
120
120
08
08
11
09
09
11
120
120
120
120
80
80
80
80
40
40
80
80
120
120
72
72
80
80
SHEET NO.
1 of 7
152
240
200
80
40
MINIMU
%
M
(MAX.) CREDIT
HOURS
1152
30%
hrs.
25%
960 hrs.
15%
576 hrs.
Expiry Date:
10%
384 hrs.
IAPOA NO.
10%
384 hrs.
10%
384 hrs.
100%
3840
hrs.
TOTAL
Date Signed:
Prof. ID Card No.
Date Issued:
Date Issued:
Expiry Date
Valid PTR No.
Date Issued:
Expiry Date
912
Candidate
PERIOD COVERED
PROJECT
SHEET NO.
2 of 7
TITLE/DESCRIPTION
& LOCATION
FROM
of Total No. of
Hours
TO
Day
Mo.
Yr.
Day
Mo.
Yr.
12
09
11
16
09
11
19
09
11
07
10
11
10
10
11
11
11
11
14
11
11
25
11
11
28
11
11
09
12
11
03
09
11
03
09
11
10
09
11
10
09
11
17
09
11
17
09
11
24
09
11
24
09
11
01
10
11
01
10
11
08
10
11
08
10
11
15
10
11
15
10
11
22
10
11
22
10
11
29
10
11
29
10
11
11
11
11
11
12
11
11
12
11
11
40
40
120
120
200
200
80
80
80
80
200
88
40
80
80
MINIMU
%
M
(MAX.) CREDIT
HOURS
1152
30%
hrs.
25%
960 hrs.
15%
576 hrs.
Expiry Date:
10%
384 hrs.
IAPOA NO.
10%
384 hrs.
10%
384 hrs.
100%
3840
hrs.
TOTAL
Date Signed:
Prof. ID Card No.
Date Issued:
Date Issued:
Expiry Date
Valid PTR No.
Date Issued:
Expiry Date
608
Candidate
PERIOD COVERED
PROJECT
SHEET NO.
3 of 7
TITLE/DESCRIPTION
& LOCATION
FROM
of Total No. of
Hours
TO
Day
Mo.
Yr.
Day
Mo.
Yr.
19
11
11
19
11
11
26
11
11
26
11
11
03
12
11
03
12
11
10
12
11
10
12
11
17
12
11
17
12
11
07
01
12
07
01
12
14
01
12
14
01
12
21
01
12
21
01
12
28
01
12
28
01
12
04
02
12
04
02
12
11
02
12
11
02
12
18
02
12
18
02
12
27
02
12
27
02
12
03
03
12
03
03
12
10
03
12
10
03
12
17
03
12
17
03
12
31
03
12
31
03
12
07
04
12
07
04
12
144
MINIMU
%
M
(MAX.) CREDIT
HOURS
1152
30%
hrs.
25%
960 hrs.
15%
576 hrs.
Expiry Date:
10%
384 hrs.
IAPOA NO.
10%
384 hrs.
10%
384 hrs.
100%
3840
hrs.
TOTAL
Date Signed:
Prof. ID Card No.
Date Issued:
Date Issued:
Expiry Date
Valid PTR No.
Date Issued:
Expiry Date
144
Candidate
PERIOD COVERED
PROJECT
SHEET NO.
4 of 7
TITLE/DESCRIPTION
& LOCATION
FROM
of Total No. of
Hours
TO
Day
Mo.
Yr.
Day
Mo.
Yr.
14
04
12
14
04
12
21
04
12
21
04
12
28
04
12
28
04
12
05
05
12
05
05
12
12
05
12
12
05
12
19
05
12
19
05
12
26
05
12
26
05
12
56
MINIMU
%
M
(MAX.) CREDIT
HOURS
1152
30%
hrs.
25%
960 hrs.
15%
576 hrs.
Expiry Date:
10%
384 hrs.
IAPOA NO.
10%
384 hrs.
10%
384 hrs.
100%
3840
hrs.
TOTAL
Date Signed:
Prof. ID Card No.
Date Issued:
Date Issued:
Expiry Date
Valid PTR No.
Date Issued:
Expiry Date
56
Candidate
PERIOD COVERED
PROJECT
SHEET NO.
5 of 7
TITLE/DESCRIPTION
& LOCATION
FROM
of Total No. of
Hours
TO
Day
Mo.
Yr.
Day
Mo.
Yr.
16
01
12
20
01
12
40
23
01
12
27
01
12
30
01
12
02
02
12
03
02
12
03
02
12
06
02
12
15
02
12
16
02
12
28
02
12
29
02
12
01
03
12
02
03
12
06
03
12
07
03
12
09
03
12
12
03
12
16
03
12
19
03
12
30
03
12
02
04
12
06
04
12
40
40
40
32
32
64
64
80
80
16
16
24
24
24
24
09
04
12
23
04
12
10
04
12
27
04
12
10
04
12
27
04
12
40
40
80
80
40
40
24
24
48
48
160
56
40
104
50
50
66
610
MINIMU
%
M
(MAX.) CREDIT
HOURS
1152
30%
hrs.
25%
960 hrs.
15%
576 hrs.
Expiry Date:
10%
384 hrs.
IAPOA NO.
10%
384 hrs.
10%
384 hrs.
100%
3840
hrs.
TOTAL
Date Signed:
Prof. ID Card No.
Date Issued:
Date Issued:
Expiry Date
Valid PTR No.
Date Issued:
Expiry Date
Candidate
PERIOD COVERED
PROJECT
10
11
12
SHEET NO.
6 of 7
TITLE/DESCRIPTION
& LOCATION
FROM
of Total No. of
Hours
TO
Day
Mo.
Yr.
Day
Mo.
Yr.
30
04
12
04
05
12
07
05
12
18
05
12
21
05
12
25
05
12
28
05
12
01
06
12
04
06
12
09
06
12
11
06
12
13
07
12
16
07
12
06
08
12
07
08
12
10
08
12
13
08
12
17
08
12
22
08
12
25
08
12
27
08
12
11
09
12
12
09
12
21
09
12
24
09
12
05
11
12
24
09
12
28
09
12
10
12
05
10
12
40
40
80
80
40
40
40
40
40
40
200
200
128
128
32
32
40
40
32
32
96
96
64
64
16
16
32
32
232
16
112
64
30
30
110
910
MINIMU
%
M
(MAX.) CREDIT
HOURS
1152
30%
hrs.
25%
960 hrs.
15%
576 hrs.
Expiry Date:
10%
384 hrs.
IAPOA NO.
10%
384 hrs.
10%
384 hrs.
100%
3840
hrs.
TOTAL
Date Signed:
Prof. ID Card No.
Date Issued:
Date Issued:
Expiry Date
Valid PTR No.
Date Issued:
Expiry Date
Candidate
PERIOD COVERED
PROJECT
TITLE/DESCRIPTION
& LOCATION
Yr.
Day
Mo.
Yr.
08
10
12
12
10
12
15
10
12
19
10
12
22
10
12
26
10
12
29
10
12
11
12
12
11
12
23
11
12
26
11
12
29
11
12
03
12
12
07
12
13
10
12
12
25
01
13
28
01
13
21
02
13
22
02
13
08
03
13
11
03
13
22
03
13
14
of Total No. of
Hours
TO
Mo.
16
FROM
Day
13
15
SHEET NO.
7 of 7
40
40
40
40
40
40
72
72
80
80
32
32
Mr. Arriola Two Storey Residence w/ attic Brgy Carmen, Silang, Cavite
40
40
240
240
152
152
80
80
80
80
120
896
NOTHING FOLLOWS
272
32
40
80
MINIMU
%
M
(MAX.) CREDIT
HOURS
1152
30%
hrs.
25%
960 hrs.
15%
576 hrs.
Expiry Date:
10%
384 hrs.
IAPOA NO.
10%
384 hrs.
10%
384 hrs.
100%
3840
hrs.
TOTAL
Date Signed:
Prof. ID Card No.
Date Issued:
Date Issued:
Expiry Date
Valid PTR No.
Date Issued:
Expiry Date
Candidate
SAMUEL B. SORIANO JR
PERIOD COVERED
PROJECT
TITLE/DESCRIPTION
& LOCATION
FROM
Corresponding
Described Tra
TO
Day
Mo.
Yr.
Day
Mo.
Yr.
18
mar
13
29
mar
13
30
mar
13
18
apr
13
19
apr
13
07
may
13
08
may
13
13
may
13
14
may
13
18
may
13
20
may
13
01
jun
13
03
jun
13
21
june
13
22
june
13
03
jul
13
04
july
13
09
jul
13
10
july
13
17
jul
13
18
july
13
29
jul
13
30
july
13
09
aug
13
136
96
80
10
aug
13
20
aug
13
21
aug
13
14
sept
13
16
sept
13
05
oct
13
07
oct
13
19
oct
13
21
oct
13
05
nov
13
09
mar
15
26
mar
15
27
mar
15
14
apr
15
16
apr
15
24
apr
15
25
apr
15
07
may
15
08
may
15
13
may
15
14
may
15
13
jun
15
15
june
15
09
july
15
10
july
15
18
july
15
20
july
15
07
aug
15
08
aug
15
nov
15
07
nov
15
20
nov
15
21
nov
15
23
jan
16
25
jan
16
03
mar
16
176
128
216
392
04
mar
16
21
mar
16
22
mar
16
22
apr
16
NOTHING FOLLOWS
1224
LEGEND
MINIMU
%
M
(MAX.) CREDIT
HOURS
MENTOR'S SIGNATU
(Pls. affix y
PR
AC
TIC
E
A.
(F
OP
B.
)
C.
D.
E.
25%
1152
hrs.
960 hrs.
15%
576 hrs.
10%
384 hrs.
10%
384 hrs.
10%
384 hrs.
100%
3840
hrs.
30%
Address:
Date
Signed:
Prof. ID Card No.
Date Issued:
Expiry
Date:
IAPOA NO.
Date Issued:
Expiry Date
Valid PTR No.
Date Issued:
Expiry Date
JR
of Total No. of
Hours
F
392
88
128
40
392
40
136
80
40
216
56
80
600
72
144
96
112
408
128
64
88
632
40
176
64
136
624
624
1104
96
272
120
224
984
624
392
464
680
4368
eress:
Signed:
. ID Card No.
e Issued:
iry
Date:
OA NO.
Date Issued:
Expiry Date
d PTR No.
Date Issued:
Expiry Date