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Contents 1. Preamble.................................................. 2 2. Objectives of the Industrial attachment...................2 3. Time Table of the Programme...............................3 4. Duties and Responsibilities...............................4 4.1 Students................................................4 4.2 Host Organisation.......................................6 4.3 Faculty Supervisor......................................7 4.4 The Industrial attachment Co-ordinator..................8 5. Administrative Policies and Procedures....................9 5.1 Work Hours..............................................9 5.2 Dress...................................................9 5.3 Leave of Absence........................................9 6. Evaluation............................................... 10 6.1 Marking and Grading....................................10 7. Grievances............................................... 11 8. APPENDICES............................................... 13

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Page 1: Internship manual reviewed

Contents

1. Preamble..............................................................................................................................2

2. Objectives of the Industrial attachment...............................................................................2

3. Time Table of the Programme.............................................................................................3

4. Duties and Responsibilities.................................................................................................4

4.1 Students.........................................................................................................................4

4.2 Host Organisation.........................................................................................................6

4.3 Faculty Supervisor........................................................................................................7

4.4 The Industrial attachment Co-ordinator........................................................................8

5. Administrative Policies and Procedures..............................................................................9

5.1 Work Hours...................................................................................................................9

5.2 Dress.............................................................................................................................9

5.3 Leave of Absence..........................................................................................................9

6. Evaluation..........................................................................................................................10

6.1 Marking and Grading..................................................................................................10

7. Grievances.........................................................................................................................11

8. APPENDICES...................................................................................................................13

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1. Preamble

In the academic year 1995/96, the Faculty of Business (then the School of Accountancy and

Management Studies) introduced three new four-year Bachelors degree programs: the

Bachelor of Accountancy (BACC), Bachelor of Business Administration (BBA) in

Management and BBA in Marketing programs. As a way of bridging the gap between theory

and practice and also introducing students to the demands of the formal workplace, students

on these programs are required to complete a compulsory industrial attachment program for

two months (June and July) during their third year long vacation. The expected output from

the industrial attachment program is a report, by each student, that meets the standards set out

in these guidelines.

2. Objectives of the Industrial attachment

The broad objective of the industrial attachment program is to introduce students to the

practical aspects of what they are studying. The specific objectives are:

1. To help students appreciate the practical applications of what they have learnt over the

previous three years on the program

2. To prepare students for integration into both the formal and informal employment sectors

3. To expose students to different organisational cultures and systems

4. To develop confidence and self-assurance in students by giving them the responsibilities

to seek their own placement, work in a new and different environment, and report back to

the Faculty regarding their learning experiences.

5. To help students sharpen their communication, interpersonal and project management

skills

6. To develop a working relationship with the business community for whom our degree

programs are designed

7. To allow the Faculty to gauge the quality of its programs by way of feedback from the

host organisations, the industrial attachment supervisors and the students.

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3. Time Table of the Programme

Co-ordinator addresses students for the first time Mid-September

Co-ordinator and students seek places Mid-September

Students leave for industrial attachment End of May the following year

Duration/Specific period of the programme 10 weeks: May – August

Visits by Faculty Supervisor, inspection of logbooks

e.t.c

From 3rd week of June

First draft Report presented to Faculty Supervisor Last week of September

Submission of Final Report by Student 2nd week of October

Marks presented to Co-ordinator 2nd week of November

Marks released by Co-ordinator To be decided upon by faculty

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4. Duties and Responsibilities

4.1 Students

Students are expected to:

1. Secure an appropriate place in conjunction with the Industrial attachment Co-ordinator in

an organisation of their choice. The Faculty regards seeking and securing a place part of

the practical training for students. This should equip students with abilities to seek jobs

on completing their studies.

2. Inform the host organisation their area of specialisation and their academic abilities. This

basically entails providing and discussing with the host organisation the departments’

handbooks which contains the syllabi for all the programmes run by the Faculty of

Business. The objective is to give the host organisations an idea of what students will

have covered at the time when they join these organisations.

3. Report on duty a day before the Industrial attachment period begins. This is to ensure

that arrangements for the student’s arrival are made and completed so that on the first day

of Industrial attachment the student can start work straight away.

4. Report for duty on a daily basis for the entire Industrial attachment period.

5. Keep a logbook in which daily activities undertaken are recorded.

6. Carry out all duties that are assigned by their supervisor or the supervisor’s delegate.

7. Dress properly and display professional behaviour, adhering to regulations established by

the host organisation, throughout their placement.

8. To observe confidentiality in relation to information obtained from within the host

organisation.

9. Present to the supervisor from the organisation logbooks for signatures at least once a

week.

10. Present a report of a minimum of 12 typed-pages to the faculty supervisor at the end of

their Industrial attachment period, on or before a date to be set by the Co-ordinator. The

report should be 12 point (font size) with a spacing of 1.5 between the lines. The page

break down should be as follows:

Introduction 0.5-1 page

Background of the company 2 pages

Management, training and employee information 2 pages

Specific job information 5 pages

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Conclusions and recommendations 2 pages

Total 12 pages

The number of pages excludes graphs, references, log book, supervisor’s report and charts.

4.2.1 Desk researchThe permission to undertake desk research may only be granted by Industrial attachment Coordinator(s) in consultation with the relevant Head of department, under the following circumstances:

a) if students fail to get attachment places or b) if they are unable to go to the field for reasons considered by the Industrial attachment

Coordinator(s) to be sound enough to warrant such permission.

Students will only be allowed to undertake desk research in very rare circumstances. The faculty shall strive to ensure that all students find attachment places.

4.2.2 Industrial attachment ACC, BIS, FIN, MGT, MKT 443

4.2.3 Desk Research Question

4.2.4 Industrial attachment ACC, BIS, FIN, MGT, MKT 443

Imagine you are the CEO of any of the companies listed below (Plc companies listed in the Botswana Stock Exchange). Discuss a brief historical background of your company. What is the mission statement of your company. What industry are you in and who are your competitors? What is your corporate strategy, business strategy, financial strategy and IT Starategy. What are your core competences.Examine the current financial and other company reports for the past three years and evaluate whether the set goals and objectives have been met given the performance as reflected in the company reports.

Determine the strengths, weaknesses, opportunities, and threats of your company. Also carry out an environmental analysis (PEST plus C)1. Explain the implementation process of the above mentioned strategies in line with the business question (mission statement) of your company.

Estimate your market share and compare it with that of your competitors.

Formulate strategic plans for the next 3 years given the current trends in your industry. How do you plan to increase your market share given your three year strategic plan. What market strategies do you plan to use to beat the competition?

Companies: (Listed Companies whose financials are accessible)2.

1 Political/Legal, Economic, Social, Technological and Competition2 Listed in the Botswana Stock Exchange

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Prepare a desk research report in accordance with the requirements in the internship/industrial attachment guidelines.

4.2 Host Organisation

The host organisation is expected to:

1. Place the student in a section or department that is relevant to his or her area of

specialisation.

2. Provide a supervisor from the organisation to whom the student will be reporting during

the entire Industrial attachment programme.

3. Develop an Industrial attachment Plan for the student so that the student has a complete

picture of what his/her attachment will entail. The plan should be designed in a manner

that gives students a holistic view of the sector or department in which the student is

placed.3 This plan can be provided verbally to the student during orientation/introduction.

The orientation should include an overview of the organisation, including its overall

purpose and specific objectives, administrative policies, (policies, regulations and

procedures), and staffing arrangements. In some cases (especially in remote areas) an

introduction to the geographic and functional community in which the organisation

operates will be appropriate.

4. Ensure that the student is properly introduced to all the people that the student will be

working with.

5. Provide the student with appropriate educational, supportive and administrative

instructions throughout his or her Industrial attachment and ensuring that the supervisor

from the organisation has sufficient time to give the student effective instructions and

guidance.

6. Ensure, through the organisation supervisor, that the student’s progress is closely

monitored by inspecting the logbook and other measures. The organisation supervisor

should sign the logbook at least once a week.

7. Participate in evaluating the student’s performance by grading them at the end of the

Industrial attachment and having verbal discussions during visits by a supervisor from the

Faculty of Business.

3 See guidelines on expected activities that should be undertaken by students of each area of specialisation.

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8. Promptly inform the Faculty of such drastic cases as gross misconduct, serious illness,

death, etc. regarding a student.

The host organisation is under no obligation to remunerate students attached to it for the

purpose of industrial attachment except in very special cases. An example of such a case

might be when students are expected to work out of station. In such a case the

organisation might have to pay for transportation and accommodation. Government

sponsored students are provided with subsistence allowance before leaving for internship.

This allowance is expected to cover the student’s personal costs for the entire internship

period. Privately-sponsored students are supposed to arrange with their sponsors to cover

these costs.

4.3 Faculty Supervisor

1. Contact (by phone) the host organisations in the first week of the Industrial attachment

period to ensure that students did arrive.

2. Visit the students in the third or fourth week of Industrial attachment. During the visit the

supervisor is expected to meet:

(a) Students:

(i) To get an idea of whether the students appreciated the role played by the section

to which they have been placed in relation to the whole organisation.

(ii) To find out if the students are well settled.

(iii) To determine activities undertaken by the students thus far, and those that are

still to be undertaken. Inspection of logbooks is an integral part of this visit.

(iv) To settle grievances or complaints, if any.

(b) Organisation Supervisor:

(i) To get progress reports on the student(s).

(ii) To remind them that they are expected to evaluate the student’s performance at

the end of industrial attachment.

(c) Any person of Authority:

(i) To acknowledge their participation in developing students of the Faculty of

Business and to secure places for the next intake.

3. Generally, to liase with the host organisation throughout the industrial attachment period.

4. Receive and grade reports of students under his or her supervision.

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4.4 The Industrial attachment Co-ordinator

The following responsibilities assume full time Industrial attachment Co-ordination:

1. Brief students about the Industrial attachment programme in the first semester.

2. Provide students with introduction letters.

3. Ensure that students are appropriately placed. It is the duty of the Co-ordinator (in

conjunction with students) to contact organisations requesting for places.

4. Assign members of Faculty students they will be supervising during the Industrial

attachment period.

5. Provide Faculty supervisors with guidelines on how to supervise students. This might

require arranging a meeting with faculty members who will have been chosen to

supervise.

6. Provide government-sponsored students with subsistence allowance and provide

privately/self-sponsored students with letters that may help them secure industrial

attachment allowance from their sponsors on request. This allowance will be paid once,

i.e. for one industrial attachment period only.

7. Provide students, at the time of departure, with a letter that introduces them as third year

students of the Faculty of Business at the University of Botswana and requesting the

addressees to assist them in their industrial attachment.

8. Receive graded reports from Faculty supervisors and publish the results. In case a student

fails to submit an acceptable report, the Co-ordinator shall resolve the matter by obtaining

the opinion of another person to be appointed by him. This other person shall be an

academic staff member.

9. Liase with faculty supervisors to attend to any queries regarding students on industrial

attachment.

10. Ensure that letters of acknowledgement are written to those companies that would have

taken students in each year.

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5. Administrative Policies and Procedures

5.1 Work Hours

Students are expected to work normal office hours, i.e. eight hours per day, five days a week.

The foregoing notwithstanding, some organisations might work outside normal working

hours, including weekends. Students may be expected to participate in such work. However,

using students to cover after office-hours, weekend or holiday work in place of regular staff is

inappropriate, unless it is clearly demonstrated that such work has educational value.

5.2 Dress

Students should dress according to the norms of the organisation in which they will practice

in order to earn the respect of their clients and their colleagues.

5.3 Leave of Absence

Students are required to work in the organisation they are attached to throughout their

placement. It should be recognised, however, that they might encounter unforeseen obstacles

that may warrant their temporary absence from work. In such cases, the supervisors from

within the organisation should adhere to the following principles:

(a) Illness

A student is entitled to up to 2 days of sick leave during the entire placement. These

days do not require make-up. If students are ill for 3 days or more, then they must

inform their faculty supervisors as soon as possible. The time lost for illnesses that last

for 3 days or more must be made-up.

(b) Personal Emergencies

Time lost due to unanticipated personal emergencies, such as the death of a close

relative, will have to be made up. Students who require 5 days of leave or more for such

purposes must seek the prior approval of their faculty supervisors.

(c) Holidays

Public holidays are treated as excused absence from work. However, the organisation

may require students to work on public holidays provided that this is also required of its

regular members of staff. Organisations should inform students well in advance of such

work. The decision to grant a student time-off for having worked over weekends or

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public holidays is at the discretion of the organisation supervisor, in keeping with the

organisation policy. Time-off for religious holidays that are not observed by the

organisation is at the discretion of the organisation supervisors. Time granted for this

purpose may have to be made up.

(d) Miscellaneous

1. Absences due to bad weather, transport difficulties and the like are to be treated at the

discretion of the organisation supervisor. Time lost for such reasons may have to be

made-up.

2. Students can attend short courses or conferences offered or organised by the host

organisation at the discretion of the organisation. The organisation supervisor will

decide whether these activities are relevant to the student’s learning objectives and

whether they warrant an excused absence from work.

6. Evaluation

Evaluation is a tool that assists in:

(i) Assessing Students ability to integrate academic knowledge with practical skills,

and to utilise these knowledge and skills in their work.

(ii) Providing students, organisation supervisors and Faculty supervisors with the

opportunity to assess the students’ performance, and to resolve situations that might

inhibit students from learning effectively.

(iii) Holding students accountable to the University of Botswana and to the host

organisation.

N.B.: Evaluations become part of the students’ academic record.

6. 1 Marking and Grading

The student’s grade will be based on the industrial attachment (practical and the evaluation

from the field supervisor), field visits and logbook(s) inspection by the academic supervisor,

industrial attachment report written by the student.

(i) The grading of industrial attachment shall be as follows:

Internship report 60%

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Visits, logbooks 10%

Assessment by host organisation supervisor 30%

Total 100%

(ii) For students undertaking desk research the grading shall be as follows:

Desk research report 90%Overall assessment, attitudes and observation by the supervisor 10%

Total 100%

(i) Failure

A student can fail in either of the two ways:

(i) Failure because the industrial attachment (practical) was not properly

conducted. In such a case the student shall be required to redo the practical in the

next academic year.

(ii) Failure to present a well-written report. In this case the student will be

expected to re-write the report with guidance from the faculty supervisor, failing

which the matter shall be handed over to the Industrial attachment Co-ordinator

for resolution.

The final results of a failing student shall be withheld until the requirements of the industrial

attachment programme have been fully satisfied.

7. Grievances

If at anytime during placement a student or the host organisation is concerned with the

placement to the extent that this concern cannot be dealt with satisfactorily in the

organisation, then the aggrieved party can request a meeting with the faculty supervisor. If a

satisfactory resolution is not obtained then the final authority rests with the Board of the

Faculty of Business in joint consultation with management of the host organisation. Possible

outcomes of this procedure might be:

(i) Altering the students’ industrial attachment plan.

(ii) Changing the students’ supervisor

(iii) Terminating the student’s placement.

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Alternative (i) and (ii) can be discussed in joint consultation with the host organisation, the

Faculty Supervisor and the student. Alternative (iii) requires the approval of the industrial

attachment co-ordinator and management of the host organisation. Both the faculty and the

host organisation reserve the unilateral right to withdraw students from placement if the

student’s performance is shown to be detrimental to the host organisation’s operations or if

unexpected circumstances warrant such action. Cases of indiscipline shall be dealt with under

the normal rules and regulations of the University of Botswana. Over and above that serious

misconduct might require the faculty to review a student’s ability to study business courses at

the University of Botswana.

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8. APPENDICES

Appendix 1

(Date)

Dear Sir/Madam:

Industrial Attachment Programme

Since introducing Tourism and Hospitality Bachelor degree programme, the Faculty of Business made it mandatory that all should undergo ten weeks of industrial attachment in organisations or organisations of their choice. Students are expected to in various tourism departments or units that are relevant to their area of specialisation.

It is envisaged that this practical experience/exposure will assist students enormously in their educational pursuits and help us in meeting the needs of industry and the business community at large. Students will need to be supervised and are expected to produce a written report on activities undertaken during the industrial attachment programme. The industrial attachment programme will run from May 18 to July 24st, 2002, or other such appropriate time for fulfilling the ten week requirement.

The purpose of this letter is to request that you give one or more of our students the opportunity to do this important training exercise in your organisation. Attached herewith, kindly find a list of broad activities that a student in each area of specialisation would normally be expected to perform during the internship. We will greatly appreciate if your organisation could integrate a student within it accordingly.

Finally, I wish to emphasise that your organisation is under no obligation to remunerate student(s) attached to it for the purposes of this programme. It is expected that students will receive subsistence allowances from their sponsors to cover their personal needs (including food, transport and accommodation).

Yours sincerely

(Name)Industrial attachment Co-ordinatorFaculty of BusinessTel: …………Fax: ………………E-mail: ……………

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Appendix 2

Broad Activity Areas According to Specialization

B.Acc:Accounts receivable/payable PayrollBank reconciliation Computerized Accounting Final accounts Inventory AccountingGeneral ledger Farming TaxationInformation and data processing Sales Tax & VAT Internal auditing Stock and financial MarketsInvoice preparation CostingProject finance/management Forecasting and planningPurchasing/supplies Investment and ForecastingStorekeepingStatutory auditing (in case of an Auditing Firm)

BBA Management Counselling PurchasingIndustrial relations Materials managementPersonnel relations Systems and procedures analysisPlanning in different capacities Production controllingProject scheduling Project managementQuality controlling StorekeepingWork method analysis Working as operators in different sections

BBA Marketing:Market analysis New Product DevelopmentMarket research Export MarketingMarketing productivity analysis Sales ForecastingPlanning Services MarketingPricing Strategic Marketing PlanCustomer Services Order ProcessingProduct/brand management Events ManagementSales Management (Merchandising)Distribution (Retailing, Wholesaling, Manufacturing)Marketing communication (Advertising, Publicity and Sales promotion)

BFIN - Finance Investment analysis BankingProject analysis InsurancePortfolio selection Real estatePortfolio management Pension fund managementAsset management Security analysisRisk management

BIS students   are being prepared to do the following jobs: Systems analysis Web developers / designers User support staffNetwork Engineers IT Project Management Network AdministratorsE-Commerce Data warehousing Application programmersDatabase Administrators Help desk support IT ManagementTechnical writers Systems developers

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Appendix 3

To: The Host Organisation (Name)Industrial attachment Programme

From: (Name)Faculty of Business

Date: ………..

Subject: Some Aspects of the Industrial attachment Programme

I must begin by thanking you for allowing our students to undergo their practical training in your organisation. I am confident that we will find this exercise of mutual benefit.

The purpose of this letter is to inform you of some of the important details of the industrial attachment. They are as follows:

1. Students should be placed in sections that are relevant to their area of specialisation and as far as it is possible, tasks should be such that they offer students a holistic view of the section they have been placed

2. The faculty expects students to keep a diary on their activities.3. Students should be assigned organisation supervisors/section leaders who will check their

diaries at least once a week.4. A staff member of the faculty will visit students at least once during the industrial

attachment period. Usually, it will be halfway through the industrial attachment. The organisation will be informed in advance.

5. Students are expected to write a report at the end of the whole exercise, which will be graded by the academic supervisor.

The industrial attachment period is from ………… to ………………..

Please, do not hesitate to contact the faculty at any time in case of any problems.

Kind Regards,

(Name)Industrial attachment Co-ordinatorTel: ……….Fax: …………

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Appendix 4

To whom it may concern:

I hereby confirm that ____________________________ ID No. ______________________,is a third year student enrolled in our Bachelor degree program, and is scheduled to undergo industrial attachment during the period of ………… to ………………….

All third year students enrolled in academic (undergraduate) programmes offered by the Faculty of Business i.e. Bachelor of Accountancy and Bachelor of Business Administration are required to undergo a mandatory industrial attachment programme

We would be grateful if you (as the known official sponsor) could financially assist this student for the entire period of internship.

For more information please do not hesitate to contact us.

Best regards,

(Name)Industrial attachment Co-ordinatorFaculty of BusinessTel: ………….Fax: …………..E-mail: ………………….

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Appendix 5

Memorandum

To: Industrial attachment Supervisors (Academic Year)Faculty of Business

Date: ………………….

Subject: Letters of Acknowledgement

The Industrial attachment Guidelines Committee, at its last meeting, decided that all supervisors have to send out letters of acknowledgement to those organisations that had our students this past academic year. The letters should be specifically addressed to each organisation (i.e. should include the specific name of the organisation and the names of students who were attached to the organisation). This, it was decided, will increase our chances of finding places for next crop of students.

To this end, find below a sample of a letter of acknowledgement that one might wish to send. If you decide that the letter suffices please make a copy. You are of course free to develop a totally different letter from this one as long as it serves the purpose.

Thanking you in anticipation of your usual co-operation. We are hoping that all letters will have left by the end of next week since this year’s batch of students have already started contacting some of these organisations seeking places.

Yours truly,

(Name)Industrial attachment Co-ordinator

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Appendix 6

To: Name of OrganisationGaborone, Botswana

From: (Name of Supervisor)Faculty SupervisorUniversity of Botswana

Date: …………………….

Subject: Letter of Acknowledgement

The Faculty of Business wishes to thank you for having given our student(s):

Student1 Student 2Student 3 Student 4Student 5 e.t.c.the opportunity to undergo their internship in your organisation

We also wish to inform you that this is an on-going programme. Each year our third year students are expected to undergo this very important practical training exercise. We will therefore, highly appreciate it if you could inform us as to the number of students you will be able to accommodate this year and sections (functional areas) they will be in.

It is important that you confirm as soon as it is possible so that I could select the most suitable candidates for you.

Best regards,

Signature_____________For Industrial attachment Co-ordinator

Tel: …………….Fax: …………….E-mail: …………….

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Appendix 7UNIVERSITY OF BOTSWANA

FACULTY OF BUSINESS

LOG SHEETS FOR USE DURING INDUSTRIAL ATTACHMENT(Third Year Students)

To: The StudentComplete this sheet neatly and clearly. In describing the work performed, be brief but include all the important details. After completing the sheet, ask your supervisor in the organisation to complete the last section

Name of Student: …………………………………………………………………………………………………..

Degree Program (BAcc/BBA-Mgt/BBA-Mktg): ………………………………………………………………...

Name of Organisation: ……………………………………………………………………………………………

Week Department

Description of Work Performed

Comments by Supervisor:

Name of Supervising Officer

Signature

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Date Position

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Appendix 8

Suggested Guidelines for the industrial attachment Report

1.0 Introduction

1.1 Objectives of industrial attachment1.2 Methodology

2.0 Background of the organisation

2.1 Discuss the historical background of the organisation.2.2 What is the mission of the organisation for which you worked?2.3 Who are the clientele of the organisation?

3.0 Management, training and employee information

3.1 How did you become oriented with the responsibilities of your job?3.2 How did your supervisor help you succeed in this position?3.3 What qualities did you have and did you develop that allowed you to succeed

in this position?

4.0 Specific job information (synopsis of operations)

4.1 Discuss your daily responsibilities.4.2 Discuss other responsibilities you had during your industrial attachment.4.3 What knowledge and skills from your course work were beneficial for you to

succeed in this position?4.4 What other courses and academic development would have been beneficial

during your industrial attachment experience?4.5 What new skills did you develop as a result of this experience?

5.0 Conclusions and recommendations

5.1 How did this industrial attachment fit your career goals?5.2 Did your career goals change as a result of this industrial attachment

experience? Explain.5.3 Discuss your feelings about the value of this industrial attachment programme.5.4 Discuss recommendations for improving the industrial attachment programme.5.5 A self-evaluation of your strengths and areas for improvement.5.6 Discuss recommendations for improving the performance of the organisation

to which you were attached.

6.0 Appendices (if any)

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Appendix 9

UNIVERSITY OF BOTSWANAFACULTY OF BUSINESS

EVALUATION OF STUDENT BY ORGANISATION SUPERVISOR

Name of Student: I/D Number:

Instructions:For each evaluation factor below, please circle the number corresponding to your assessment of the student, using the following scale:5 = Excellent; 4 = Very Good; 3 = Good; 2 = Satisfactory; 1 = Unsatisfactory.

Quality of work 1 2 3 4 5

Quantity of work 1 2 3 4 5

Oral communication 1 2 3 4 5

Written communication 1 2 3 4 5

Co-operation 1 2 3 4 5

Ability to plan and organise her/his work 1 2 3 4 5

Judgement 1 2 3 4 5

Initiative 1 2 3 4 5

Time-keeping 1 2 3 4 5

Analytical ability 1 2 3 4 5

Others (specify) 1 2 3 4 5

______________________________________ 1 2 3 4 5

______________________________________ 1 2 3 4 5

______________________________________ 1 2 3 4 5

______________________________________ 1 2 3 4 5

OVERALL ASSESSMENT 1 2 3 4 5

Additional comments: ________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

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Name of Organisation: ________________________________________________________

Name of Officer: ____________________________________________________________

Signature of Officer: __________________________________________________________

Rank of Officer: _____________________________________________________________

Date: ______________________________________________________________________

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