Letter For Participation in Internship Manila Campus

STUDENT APPLICATION LETTER
_________________
Date
DR. CHARITO M. BERMIDO

Dean, School of Medical Technology
CEU
Through: Mr. Mark Rodrigo D. Mendros

Coordinator for Internship
Dear Dr. Bermido:
This is to express my intention to join the limited Face to Face class for our
clinical internship. I have read, understood and agreed with all the policies and
guidelines which will be implemented during the conduct of the limited Face to Face
class. I will be travelling to ________Campus by_______________________ from
(Means of Transportation)
________________________________
(Present Address)
I am hoping for your approval regarding this matter.
Very truly yours,
_______________________
Signature over Printed Name
_______________________
Student Number
_______________________
Contact Number
_______________________
Email Address
DECLARATION OF CONSENT AND UNDERTAKING
We/I the undersigned, hereby declare the following:
1.We are/I am the parent(s)/legal guardian of ________________________,

(Dependent, Full Name) a student of the
_______________________(School/College/Department) with student number
________________________;
2. We were/I was oriented by Centro Escolar University (“CEU”) of the nature of

the limited face to face classes and we are fully aware that it is an option for
our/my child/dependent to go about his/her studies, and participation herein
is fully voluntary;
3. We are/ I am fully aware of the risks connected with the participation by

our/my son/daughter/dependent on the on-campus / off-campus activities
connected with the limited face to face classes during this time of pandemic,
and acknowledge that no guarantee can be made as to whether participation in
these face-to-face activities is totally free from exposure to COVID 19.
4. Fully aware of the foregoing:
we/I do not give our/my consent for ___________________ to
proceed with his/her studies under the _________________ program of the
School/College/Department of __________________ through participation in the
Limited Face to Face classes to be conducted by CEU.
we/I hereby give our/my consent for ___________________ to

proceed with his/her studies under the _________________ program of the
School/College/Department of __________________ through participation in
the Limited Face to Face classes to be conducted by CEU.
By giving our/my consent, we /I likewise agree to the following undertakings:

1. We/I will ensure the safety of all concerned in the conduct by CEU of
Limited face – to – face classes by complying with all the applicable policies and
protocols such as but not limited to preventing our/my child/dependent to go
to class when not feeling well, and disclose all the necessary health information
as may be required by the University.
2. We/I will obtain the necessary health insurance coverage and/or Philhealth
membership for our/my child/dependent, as well as to undergo all the
necessary tests and physical examination prior to attending the Limited Face to
Face classes, including getting a negative PCR test 48 hours prior to initial
entry on campus and carrying at all times a Hygiene Kit in accordance with
DOH specifications.
3. For the duration of the Limited Face to Face classes, our/my
child/dependent shall not use public transportation. We/I acknowledge that
we/I have the option to exclusively use private transportation to and from said
Limited face to face classes, or to avail of the services of an accommodation
facility accredited by the City of Manila, via the Rental bee app for CEU
Campus. In CEU Makati, arrangements of the same shall be complied with.
4. In case our/my son / daughter / dependent develops symptoms and become
sick of COVID-19, we are/I am responsible for all reasonable consequences in
connection with the care and treatment necessary during this period, including
the necessary coordination with CEU in accordance with the health protocols
established by the IATF and DOH.
5. In the event that our/my son / daughter / dependent develops symptoms
and/or be infected with COVID-19 during the duration of his/her face-to-face
activities inside / outside the University, we/I hereby give permission to CEU
to provide necessary assistance for the said dependent and to take the
appropriate measures, including arranging for transportation if necessary, to
the nearest emergency medical facility. We/I also agree that even though CEU
will assist in the transport of the patient, we/I will abide by the protocol of the
agencies of the government and the school that as the family/guardian, we/I
will be the one responsible for the transport of the patient to our/my
home/dormitory or boarding house/ hospital/ isolation or quarantine facility
as required and come immediately to school when informed by school officials.
IN WITNESS hereof, we/I hereby set our/my hand this ____ day of
____________, 2021 at ________________________________.
__________________________
Parent(s)/Guardian
_______________________________
Address
_______________________________
Contact Number
_______________________________
Name of Health Insurance and Policy #
Republic of the Philippines )
)Ss.
Subscribed and sworn to me this ___ day of _______________________ at

_______________ affiant exhibiting to me his/her ____________________________ as
competent proof of identification bearing his/her signature and photograph.
NOTARY PUBLIC
Doc No.
Page No.
Book No.
Series of 2021

Letter For Participation in Internship Manila Campus

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STUDENT APPLICATION LETTER

DR. CHARITO M. BERMIDO

Through: Mr. Mark Rodrigo D. Mendros

Dear Dr. Bermido:

I am hoping for your approval regarding this matter.

Very truly yours,

We/I the undersigned, hereby declare the following:

1.We are/I am the parent(s)/legal guardian of ________________________,

2. We were/I was oriented by Centro Escolar University (“CEU”) of the nature of

3. We are/ I am fully aware of the risks connected with the participation by

we/I hereby give our/my consent for ___________________ to

By giving our/my consent, we /I likewise agree to the following undertakings:

Subscribed and sworn to me this _ day of _____________________ at

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